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Obstetrical Needs Assessment Form - UPMC Health Plan 2026
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- Click ‘Get Form’ to open the Obstetrical Needs Assessment Form in our editor.
- Begin by filling out the OB/GYN Office Information section. Enter 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 document any Past OB Complications and Current Risks. If there are none, check the appropriate boxes provided.
- Fill in details regarding Active Medical/Mental Health Conditions and Social, Economic, Lifestyle factors that may affect the pregnancy.
- Finally, review all sections for completeness before saving or submitting the form through our platform.
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Related links
The provision of the highest quality of clinical care for women with complications in pregnancy; gynecologic problems, gynecologic malignancies, infectiousRead more
The information requested in the middle of the form allows the MCOs and ACCESS Plus to risk-stratify our members and to make appropriate referrals into our CaseRead more