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Get Newborn Referral Form
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How to fill out the Newborn Referral Form online
Completing the Newborn Referral Form online is an essential step for notifying Medi-Cal about the birth of a child. This process ensures that the newborn is eligible for important benefits. This guide will provide you with detailed, step-by-step instructions to fill out the form accurately.
Follow the steps to fill out the Newborn Referral Form online:
- Press the ‘Get Form’ button to access the Newborn Referral Form and open it in your preferred digital editor.
- In Section A, enter the mother’s information, including her full name, date of birth, and Medi-Cal ID or Social Security number. Fill in the mailing address and telephone number.
- Move to Section B to input the newborn’s details. Begin with the first newborn’s name, date of birth, and gender. If there are additional newborns, repeat this process for each.
- Indicate where the baby was born by providing the hospital or clinic name and its address, including the city and state.
- Answer whether the baby and mother will reside in the same household by selecting 'Yes' or 'No.' If 'No,' specify if the mother has relinquished her rights.
- In Section C, if you are completing the form on behalf of the mother and are not a close family member, fill out this section with your information and signature. Include your title, Medi-Cal ID number, and contact number.
- After filling out all sections, review the form for accuracy. When satisfied, you can save the changes, download a copy, print it, or share it as needed.
Complete the Newborn Referral Form online today to ensure timely eligibility for your newborn.
Medi-Cal operates as California’s Medicaid program, providing health coverage to eligible individuals, including children. It covers a variety of medical services, ensuring families can access necessary care. For newborns, submitting the Newborn Referral Form is crucial to start benefiting from the program right away.