Get the free Pregnancy Notification Report - Anthem

Pregnancy Notification Report All providers should complete and submit this assessment within seven days of assessment of each pregnant Medicaid Member. Fax this form to 800-964-3627. SECTION A: OB

How to fill out pregnancy notification report

How to fill out pregnancy notification report:

1. Begin by gathering all the necessary information such as the name of the pregnant individual, their contact information, and their expected due date.
2. Next, fill out the details about the employer or organization to whom the report is being submitted. Include the employer's name, address, and contact information.
3. Provide information about the pregnancy, including the date of conception and the expected date of delivery. It may also be necessary to mention any complications or high-risk factors associated with the pregnancy.
4. Include any relevant medical documentation or certificates that support the pregnancy notification. This may include doctors' notes, ultrasounds, or medical reports.
5. Ensure that all the information provided in the report is accurate and up to date. Double-check for any errors or missing details before submitting the report.

Who needs pregnancy notification report:

1. Pregnant employees who are required to inform their employers about their pregnancy as per company policies or legal requirements.
2. Employers or organizations that need to be aware of an employee's pregnancy in order to provide appropriate accommodations or support.
3. Government agencies or institutions that require individuals to submit a pregnancy notification report for administrative or statistical purposes.

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What is pregnancy notification report?

Pregnancy notification report is a document that informs an employer about an employee's pregnancy.

Who is required to file pregnancy notification report?

Employees who are pregnant are required to file a pregnancy notification report.

How to fill out pregnancy notification report?

The pregnancy notification report can usually be filled out online or on paper. Required information includes the employee's name, expected due date, and any specific requests or accommodations related to the pregnancy.

What is the purpose of pregnancy notification report?

The purpose of the pregnancy notification report is to ensure that employers are aware of their employee's pregnancy and can provide necessary support or accommodations.

What information must be reported on pregnancy notification report?

The pregnancy notification report typically requires the employee's name, expected due date, and any specific requests or accommodations related to the pregnancy.