Who Completes the Verification Form
To be valid, a pregnancy verification letter must be filled out by one of the following:
- Doctor or physician assistant
- Nurse or nurse practitioner
PREGNANCY VERIFICATION LETTER
To Whom It May Concern:
[PATIENT NAME] is approximately [#] weeks pregnant.
Projected due date (EDC) is: [MM/DD/YYYY]
Number of children expected: [# OF CHILDREN]
Medical Professional Signature ________________________ Date [MM/DD/YYYY]
Printed Name [MEDICAL PROFESSIONAL NAME]
Practice/Facility Name [PRACTICE/FACILITY NAME]
Address [ADDRESS] Phone Number [PHONE NUMBER]
When Formal Verification of a Pregnancy is Needed
The most common reason women need proof of pregnancy is to apply for Medicaid healthcare insurance and governmental assistance programs. In most states, Medicaid provides healthcare coverage to qualifying low-income pregnant women.
Additionally, some employers may request proof of pregnancy from employees who apply for maternity leave. Adoption agencies and abortion clinics will often require pregnancy verification as well.
When someone suspects they are pregnant, they can follow the below steps to confirm and verify their pregnancy.
- Take a personal pregnancy test.
- If the test is positive, schedule an appointment with a healthcare provider.
- If the medical professional confirms the pregnancy, request a pregnancy verification letter as proof.