Get Pregnancy Notification Report. Pregnancy Notification Report

Filling out the Pregnancy Notification Report is an important step in managing prenatal care effectively. This guide will walk you through each section of the form to facilitate a smooth completion process.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the Member Information section, fill out your name, CIN, health network, phone number(s), address, city, date of birth (DOB), and ZIP code. This information helps in identifying you and maintaining contact.
3. Proceed to the First Prenatal Appointment section. Enter the date of your first prenatal appointment, as well as details concerning Gravida (G), Last Menstrual Period (LMP), due date (EDC), and whether it is a high-risk pregnancy.
4. In the Member Conditions section, check the 'at risk' box if applicable, and provide any necessary comments about diagnosed conditions.
5. List each condition under the Member Conditions section, and check the 'At Risk' box if the condition is present. Provide interventions or comments as needed for a clearer understanding of your health situation.
6. Fill out the Provider Information section, including the provider's name, phone number, office contact name, and indicate if the provider is CPSP certified.
7. Lastly, navigate to the Perinatal Support Services section and circle how services will be offered to you, indicating any coordination with CalOptima or requesting assistance from your provider office.
8. Once all sections are completed, review the form for any errors. After ensuring all information is accurate, save your changes. You can then download, print, or share the form as needed.

Complete your Pregnancy Notification Report online today and ensure your prenatal care is well-managed.