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Fact Sheet: Wisconsin's "Unborn Child Protection Act

Fact Sheet: Wisconsin's "Unborn Child Protection Act 2026

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The document outlines the requirements and procedures for the At Risk Pregnancy (ARP) Medical Information/Verification form used in Wisconsin's W-2 program. It is designed to collect information from pregnant women who are unable to work due to high-risk pregnancies, specifying eligibility criteria such as marital status and custody of children. The form must be completed by a physician and includes sections for medical verification and patient details.

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Click ‘Get Form’ to open the Fact Sheet in the editor.
Begin by entering the patient’s full name and birthdate in the designated fields. Ensure accuracy as this information is crucial for identification.
Input the patient’s due date, which is essential for determining eligibility for the W-2 ARP placement.
Indicate whether the patient has a high-risk pregnancy by selecting 'Yes' or 'No'. If 'Yes', provide details about the cause of the high-risk status in the comments section.
Fill in the start date for when the patient became unable to work due to their high-risk pregnancy, if applicable.
Complete the physician’s information, including specialty area, NPI, office address, and contact details. Ensure that all fields are filled out legibly.
Finally, have the physician sign and date the form before submitting it back to the agency listed at the top.

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Versions	Form popularity	Fillable & printable
2020	4.2 Satisfied (34 Votes)
2016	4.3 Satisfied (31 Votes)
2009	4.2 Satisfied (49 Votes)

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Fact Sheet: Wisconsin's "Unborn Child Protection Act 2026

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