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Get and Sign POSTPARTUM ENCOUNTER FORM Attachment B 2018-2022

Get and Sign POSTPARTUM ENCOUNTER FORM Attachment B 2018-2022

Use a fidelis babycare program 2018 template to make your document workflow more streamlined.

This form and submit to Fidelis Care as soon as our member has been seen for her postpartum visit 21 to 56 days after delivery. The encounter form must be signed and dated. Group Name Provider Name Tax Identification must be completed Member Name Member ID Member Phone // Member Date of Birth Date of Delivery EDC PROVIDER SIGNATURE DATE Postpartum Visit Submission of a valid postpartum date 21-56 post delivery date will qualify for a 200. Submit this encounter form no later than 14 weeks from...
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