Get Newborn Notification Form - Advicare Health

Completing the Newborn Notification Form for Advicare Health ensures the proper notification of your newborn's birth to the health plan. This guide provides step-by-step instructions for filling out the form online, ensuring a smooth process to secure necessary care for your newborn.

Follow the steps to complete your form with ease.

1. Press the ‘Get Form’ button to acquire the form and open it in your chosen document editor.
2. Enter the admission date by filling in the fields marked with __/___/___ format.
3. Provide the mother’s name in the designated field for last and first name.
4. Fill in the mother’s date of birth using the format ___/___/________.
5. Complete the street address by writing the full address in the specified field.
6. Indicate the city and state where the mother resides.
7. Specify the county of residence for the mother in the provided space.
8. Enter the mother’s contact phone number in the designated field.
9. Fill out the name of the delivery hospital.
10. Provide the contact name from the hospital in the appropriate section.
11. Enter the newborn’s name in the format Last, First.
12. Input the birth date of the newborn in the given format ___/___/___.
13. Record the birth weight in the designated field.
14. Include the mother’s Medicaid ID number.
15. Complete the zip code field for the mother’s address.
16. Fill in the discharge date using the format ____/_____/___.
17. Provide the hospital NPI number in the specified area.
18. Enter the phone number of the hospital.
19. Specify the newborn's gender.
20. Complete the Medicaid ID field for the newborn.
21. Fill in the Apgar score and gestational age for the newborn.
22. Indicate the fax number for correspondence.
23. Repeat steps 11 to 21 for any additional newborns if applicable.
24. Choose the method of delivery and provide the NICU admission date if applicable.
25. Complete the diagnosis description sections using the ICD-9 codes.
26. Choose the discharge disposition and provide the relevant dates.
27. Once all fields are completed, save your changes, and ensure you download, print, or share the completed form as needed.

Start completing your Newborn Notification Form online today!