Get Obstetrical Needs Assessment Form - Provider ... - Keystone First

Completing the Obstetrical Needs Assessment Form is essential for Medicaid recipients participating in a HealthChoices program. This guide provides clear, step-by-step instructions to assist users in accurately filling out the form online.

Follow the steps to successfully complete the Obstetrical Needs Assessment Form.

1. Press the ‘Get Form’ button to obtain the Obstetrical Needs Assessment Form and open it in your document editor.
2. Begin with the OB/GYN office information section. Fill in the practice name, phone number, fax number, provider MAID number, and dates for initial fax, 28-32 week fax, and postpartum fax. This section should be completed by a healthcare professional.
3. Next, complete the member’s information section by providing the member’s first and last name, date of birth, member ID, age, health plan membership details, and contact information. Ensure all required fields are filled to avoid delays.
4. In the next section, indicate if the member has had any previous obstetrical complications or current risks. Check the appropriate boxes to reflect the member's medical history accurately.
5. Complete the middle section regarding the member’s current medical and mental health conditions, as well as social, economic, and lifestyle factors affecting the pregnancy.
6. Document the delivery information, including the delivery date, gestational age, method of delivery, and birth weight. Include details about the postpartum visit and any relevant screening for depression or referrals needed.
7. Review all entries to ensure accuracy, complete any missing information, and ensure no section is left blank. It's helpful to use a black pen and print using capital letters in physical form submissions.
8. Upon completion, you can save changes to the document, download it for your records, print a copy, or share the form with the necessary parties.

Complete your Obstetrical Needs Assessment Form online today to ensure timely enrollment in maternity programs.