Get Dmap 2410. Ohp Newborn Notification Form

Filling out the DMAP 2410. OHP Newborn Notification Form online is a straightforward process that enables you to report essential information about newborns promptly. By following this guide, you can ensure that all necessary details are accurately submitted to facilitate processing.

Follow the steps to complete the form efficiently.

1. Click ‘Get Form’ button to access the DMAP 2410 OHP Newborn Notification Form in your preferred editor.
2. Provide the reporting provider information. Fill in your business or clinic name, address, phone number, and fax number. Specify a contact person for any follow-up.
3. In the newborn information section, indicate if you are reporting multiple births by selecting 'Yes' or 'No'. Enter the date of birth for the newborn.
4. Complete the details for each newborn including their last name, first name, middle initial, title, and sex (male or female).
5. Fill in the birth mother information. Provide her last name, first name, date of birth, social security number, and Oregon Medicaid ID.
6. Check the newborn status that applies. Indicate if the newborn was discharged with the birth parent, placed in Child Welfare custody, adopted, deceased, or any other status. If applicable, enter the corresponding dates for the selected status.
7. Follow the instructions for submitting the completed form. Ensure that you only submit the form once for each birth to avoid delays.
8. At the end, save your changes, and if necessary, download, print, or share the completed form as needed.

Complete your DMAP 2410 OHP Newborn Notification Form online today to ensure timely processing.