How Do You Fill Out a Verification of Pregnancy Form?


Quick Answer

To fill out a verification of pregnancy form, fill in the name, address, month pregnancy began, date of expected delivery and the number of births anticipated, according to the Texas Health and Human Services Commission. The address of a physician, nurse practitioner, registered nurse or approved medical professional must be provided in addition to a signature from the professional verifying pregnancy and the condition of the patient.

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Full Answer

Patients must supply a contact number for the expectant mother and attending physician on a pregnancy verification form and indicate if the patient is exempt from working while pregnant, explains the Texas Health and Human Services Commission. A signature from a medical professional is required on the form, and patients must sign the form, providing the organization permission to contact health care providers when determining eligibility for services.

A pregnancy verification form is commonly used by state offices of health and human services to determine if individuals are eligible for benefits, including cash assistance, monthly food stipends and medical care, according to the Texas Health and Human Services Commission. A caseworker must input the case number on the form and process the paperwork to determine eligibility while verifying pregnancy status with health care professionals.

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