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Hospital

FOR HOSPITAL USE ONLY

Hospitals should use the specifically-marked application for any pregnant inpatient who presents without coverage on or before date of delivery.

The Application must be signed and completed, in its entirety, and faxed to CoverKids at 1-866-913-1046.

English Application

Aplicacion en espanol

 

Use the CoverKids Birth Reporting form only for pregnant women enrolled in CoverKids.

English

Espanol