This is a photocopied four-page, stapled document called "Rules and Regulations / of the / Board of Health / Commonwealth of Virginia / Governing the Practice of / Midwifery", dated April 1, 1980. The document was sent to midwife Amanda Carey Carter by the Bureau of Maternal and Child Health of the Virginia Department of Health for her review (see NMAAHC 2011.75.18.1).