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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.
To add your newborn to Medi Cal California, you should complete a Newborn Referral Form as soon as possible after birth. You can typically do this through your healthcare provider or local Medi Cal office. Make sure you have your baby's birth certificate and any relevant insurance information on hand when you submit the form.
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