Maternal and Infant Support Services 03-01 - State of Michigan - michigan 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the beneficiary's personal information, including name, date of birth, and Medicaid ID number. Ensure accuracy as this information is crucial for service eligibility.
3. Proceed to the health information section. Here, document any relevant maternal health issues, previous pregnancies, and current health concerns. This will help assess the need for support services.
4. In the risk screening section, answer all questions honestly. A check on any asterisk (*) question indicates an automatic referral for services. Make sure to provide detailed responses where necessary.
5. Complete the plan of care by outlining specific goals and interventions based on the assessment results. This should include follow-up plans and any referrals needed.
6. Review all entered information for completeness and accuracy before submitting the form through our platform.

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