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Proof of pregnancy letter 2026

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  1. Click ‘Get Form’ to open the proof of pregnancy letter in our editor.
  2. Begin by filling in the recipient's details at the top of the form. Enter 'Vicky Barberini, Dosimetry Coordinator, Box 0942' followed by 'Office of Environmental Health and Safety, UCSF'.
  3. In the section labeled 'I believe I became pregnant in', input the month and year of your pregnancy. This is a crucial detail for compliance with NRC regulations.
  4. Review the statement regarding radiation dose limits to ensure you understand your rights and responsibilities during your pregnancy.
  5. Sign the document in the designated area for your signature, then print your name clearly below it.
  6. Fill in today’s date and provide your phone number for any necessary follow-up communication.

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