Get Universal Ob Form - Intotal Health

Filling out the Universal OB Form - INTotal Health is a crucial step for individuals seeking managed care during obstetric care. This guide will walk you through each section of the form to ensure that you provide all necessary information accurately and efficiently.

Follow the steps to complete your Universal OB Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient's information. Fill in the member's name, age, current address, date of birth, ID number, and phone numbers (home and cell). Ensure all information is current and accurate.
3. In the provider information section, provide the name of the facility, the name of the obstetrician, their NPI number, and a contact phone number and fax number.
4. Complete the patient history section by entering the current weight, pre-pregnancy weight, height, and the date prenatal care was initiated. Additionally, note the last menstrual period, the number of pregnancies (Gravida), live births, and the date of the last sonogram performed along with the estimated date of confinement (EDC).
5. In the risk assessment section, specify any planned C-section indications and check any relevant risk factors, such as smoking, substance abuse, or HIV/AIDS. Provide an explanation if the pregnancy is considered high risk.
6. Address the previous adverse pregnancy outcomes by marking any that apply, including premature births, stillbirths, or fetal complications.
7. If applicable, describe any current pregnancy complications in the corresponding section, listing issues like maternal bleeding or preeclampsia.
8. Review the areas pertaining to Medallion II and FAMIS Managed Care Organizations and select the appropriate organization to which the form will be submitted.
9. Once you have completed all sections, review the entire document for accuracy. Make any necessary changes, then save your changes, download, print, or share the form as needed.

Complete your Universal OB Form online today for a smoother healthcare experience.