Loading
Get Kaiser Permanente 03925-013 2013
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Kaiser Permanente 03925-013 online
The Kaiser Permanente 03925-013 form, also known as the prenatal intake questionnaire, is an essential document for expectant individuals. This guide will walk you through each section of the form, ensuring you can complete it accurately and comfortably online.
Follow the steps to fill out the Kaiser Permanente 03925-013 online.
- Press the ‘Get Form’ button to obtain the form and open it in the online editor.
- Begin filling in your personal details, including your medical record number, name, address, city, state, phone number, date of birth, and age. Ensure all information is accurate and complete.
- In the emergency contact section, provide the name and phone number of a person to contact in case of an emergency. Specify their relationship to you.
- Complete the fields for ethnicity, religious preference, language preference, and marital status by selecting the appropriate options.
- Fill in your occupation and employer name along with the location of your employment.
- In the OB/GYN status section, indicate the first day of your last period and whether you are currently breastfeeding. Also, select your planned delivery site.
- Detail your pregnancy circumstances by indicating your living situation and answering related questions, such as the relationship status and if there are any unsafe conditions.
- Answer the past medical history questionnaire by checking 'Yes' or 'No' for each relevant medical condition. Include comments if required.
- Provide details about your obstetric history, including information on up to six previous pregnancies. Use the provided structure for each pregnancy, including outcomes, delivery details, and any medical issues.
- Review all the information you have entered for accuracy before proceeding.
- Once complete, you can save changes, download, print, or share the form.
Start filling out the Kaiser Permanente 03925-013 online today to ensure a smooth onboarding process for your prenatal care.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
In California, individuals who demonstrate financial need may qualify for assistance with their medical bills through Kaiser Permanente 03925-013. This includes those with low income, uninsured individuals, or those facing significant medical expenses. For details on applying, visit the Kaiser website or discuss your situation with a Kaiser representative.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.