Birth notification form pdf 2026

1. Click ‘Get Form’ to open the birth notification form in the editor.
2. Begin by filling in the 'Facility Name / ID #' at the top of the form. This identifies where the birth took place.
3. Complete all fields marked with an asterisk (*) for prompt processing, including 'Mother First Name' and 'Health Plan ID Number'.
4. Indicate the 'Birth Type' by selecting either Single or Twin, and specify the number of births if applicable.
5. Fill in the 'Date of Birth' for each baby, ensuring you select their gender as either Male or Female.
6. Provide details on delivery type (Vaginal or C-Section) and include any relevant diagnosis codes for both mother and baby.
7. Finally, review all entered information for accuracy before submitting via electronic notification or faxing to the appropriate Health Plan.

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