Pregnancy Notification Form - WellCare of Georgia 2026

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Click ‘Get Form’ to open the Pregnancy Notification Form in the editor.
Begin by filling in the member's name, ID, and contact information. Ensure all details are legible and accurate.
Next, provide your physician's name and contact details, including their fax number. This is crucial for communication regarding your care.
Indicate important dates such as the expected date of delivery (EDD) and the last menstrual period (LMP). These fields are essential for tracking your pregnancy timeline.
Complete the sections on social risk factors and maternal medical history by checking applicable boxes and circling 'Yes' or 'No' where required. This helps assess case management needs.
Finally, ensure that the provider completing the form signs it and includes their title along with the date. Review all entries for accuracy before submission.

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