Pregnancy Notification Form MHFL 7-08 - Molina Healthcare 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the member information section. Enter the member’s name, address, date of birth, and contact numbers. Ensure all fields are completed accurately.
  3. Next, provide your office information. If you are the primary care provider (PCP), include the name of the OB/GYN that the member will be using if known.
  4. Complete any relevant details regarding current and past pregnancies, including high-risk conditions if applicable.
  5. Finally, fax the completed form to Molina Healthcare’s Motherhood Matters Program at (866) 440-9791. If you have questions, reach out at (866) 472-4585 for assistance.

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