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Click ‘Get Form’ to open the Obstetrical Needs Assessment Form in our editor.
Begin with the OB/Gyn Office Information section. Fill in your practice name, phone number, fax number, and provider MAID# accurately.
Next, complete the Member’s Information section. Ensure you provide the member's full name, date of birth, age, and MCO Member ID#. Don't forget to indicate if they are a Healthy Beginnings Plus Member.
Proceed to fill out the Current Risks and Active Medical/Mental Health Conditions sections. Check boxes as applicable and provide details for any identified risks.
For each prenatal visit, document relevant dates and information such as delivery method and postpartum details in their respective sections.
Review all entries for completeness. Ensure no fields are left blank before submitting the form.
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