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Shared Maternity Care Affiliate Credentialing Application Triennial 1 January 2017 31 December 2019 (application to use from 1/11/2018) General Practitioners and Obstetricians PERSONAL DETAILS Title:
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How to fill out shared maternity care affiliate
How to fill out shared maternity care affiliate
01
Obtain the shared maternity care affiliate form from the respective healthcare provider or agency.
02
Fill out the personal information section, including your full name, address, contact number, and date of birth.
03
Provide details about your pregnancy, such as the estimated due date, number of previous pregnancies, any complications, and current prenatal care provider.
04
Fill out the insurance information section, including your healthcare insurance provider, policy number, and contact details.
05
Sign and date the form to certify the accuracy of the information provided.
06
Submit the completed shared maternity care affiliate form to the designated healthcare provider or agency.
07
Keep a copy of the filled form for your records.
Who needs shared maternity care affiliate?
01
Shared maternity care affiliate is needed by pregnant individuals who prefer to receive prenatal care from both a primary care provider and an obstetrician.
02
It is particularly beneficial for those who want to maintain continuity of care with their primary care provider while also accessing specialized obstetric care during pregnancy.
03
This arrangement is often suitable for low-risk pregnancies where the primary care provider and obstetrician work collaboratively to ensure the well-being of both the mother and baby.
04
Individuals seeking a holistic approach to prenatal care, integrating both primary care and obstetric expertise, can benefit from shared maternity care affiliate.
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What is shared maternity care affiliate?
Shared maternity care affiliate is a program that allows pregnant women to receive prenatal care from both a primary care physician and an obstetrician.
Who is required to file shared maternity care affiliate?
Healthcare providers who offer shared maternity care affiliate services are required to file the necessary documentation.
How to fill out shared maternity care affiliate?
To fill out shared maternity care affiliate, providers must include information about the pregnant woman, the primary care physician, and the obstetrician involved in the care.
What is the purpose of shared maternity care affiliate?
The purpose of shared maternity care affiliate is to ensure that pregnant women receive comprehensive prenatal care from both a primary care physician and an obstetrician.
What information must be reported on shared maternity care affiliate?
Providers must report the names of the pregnant woman, primary care physician, and obstetrician, as well as details about the care provided.
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