Get Wisconsin Prenatal Care Coordination Application

The Wisconsin Prenatal Care Coordination Application is a crucial document designed to gather necessary information for certifying providers and authorizing medical services for eligible members. This guide will provide you with comprehensive, step-by-step instructions on how to fill out the application online, ensuring that you provide accurate and complete information.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section I, which gathers general information. Fill out all required fields including the member's name, date of birth, age, ethnicity, race, education level, marital status, and contact information. Make sure that the information is accurate and complete to avoid any delays in processing.
3. Move on to Section II, which pertains to the current pregnancy. Record essential dates such as the expected due date and the date of the member's last menstrual period. Assess the mother's prenatal care scheduling and note any related factors such as weight and multiple pregnancies.
4. Proceed to Section III, where you will document the pregnancy history. Include the number of previous pregnancies, births, miscarriages, and any low or high birth-weight experiences. Each detail is significant for the assessment of potential risks.
5. In Section IV, evaluate and record any health concerns. This includes questions about dental health, substance use, domestic violence, and mental health challenges. Each response may indicate risks that need additional support or management.
6. Finalize the process by reviewing Section V, which must be completed by a qualified professional. Confirm eligibility for Prenatal Care Coordination services, provide the number of risk factors or age, and make sure to obtain the necessary signatures and dates.
7. Once all sections are filled out accurately, save changes, and complete your application by downloading, printing, or sharing the form as needed.

Encourage completing your application online to ensure a smooth process for accessing Prenatal Care Coordination services.