Complete Part II only if newborn will not live with the mother.
Release from the hospital: will the newborn live with the mother? If NO, skip to Part II.
Part IV: only enter information for providers that are able to bill Medicaid for the Newborn.
Part V: to be completed by Medicaid.
| Question | Answer |
|---|---|
| Form Name | BHSF Newborn Request Form |
| Form Length | 1 page |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Edition | Rev 09/19 |
| Issuing agency | Louisiana Department of Health |
| Other names | BHSF Newborn Request Form, Request for Newborn Medicaid ID Number, newborn Medicaid ID, Louisiana Medicaid newborn |
| Official source | BHSF Newborn Request Form (Rev 09/19), Louisiana Department of Health |
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