Free Printable Pregnancy Verification Form (MS Word)

A pregnancy verification form is a written document used to indicate evidence of a positive pregnancy test. The form confirms that a woman is pregnant. It gives further details concerning certain pregnancy tests.

The pregnancy verification form is basically issued by a licensed medical expert who is taking care of the pregnant mother.

Purpose of the pregnancy verification form:

The pregnancy verification form gives details of an individual’s pregnancy that includes the following;

  • The hospital/clinic visitation date
  • The estimated conception date
  • The last menstrual period
  • The estimated delivery date
  • Age of gestation
  • The number of fetuses

Moreover, it is important to record a pregnant woman’s information because it indirectly records the fetus’s growth and development. It also assists gynecologists in understanding the health status of the expectant woman. The gynecologist can also understand the growth of the developing fetus over time that may be important during future clinic visits. Let us discuss below some reasons that why this form is important;

  • At first, this form serves as evidence of a positive pregnancy test. So, the pregnant woman can use it to file for maternity leave. She also makes time-off requests from their employer, particularly where one has to make several visits to the clinic or medical expert.
  • From insurance companies, when one is claiming health insurance for pregnancy, a pregnancy verification form is very important. By having this firm, she doesn’t have to go through the long and tedious insurance claim investigations from the insurer.
  • This form is evidence of pregnancy based on medical practitioner’s tests. During future medical examinations and tests on the mother and fetuses’ health, this form will come in handy.
  • The document also keeps track of medical history and complications associated with pregnancy. It is generally estimates when the child could be born. When answering questions such as the underlying medical issues, such as allergies, morning sicknesses, etc., this may be very helpful to a partner, educational entity, or even an employer. You may also like Maternity Leave Letter of Intent.

Fillable Pregnancy Verification Form

fillable pregnancy verification form
File Format
Word (doc, docx)
Size: (58 KB)

Pregnancy Verification Letter

pregnancy verification letter
File Format
Word (doc, docx)
Size: (15 KB)

Free Printable Pregnancy Verification Form

free printable pregnancy verification form
File Format
Word (doc, docx)
Size: (28 KB)

Pregnancy Confirmation Form

pregnancy confirmation form
File Format
Word (doc, docx)
Size: (39 KB)

Pregnancy Verification Statement Form

pregnancy verification statement form
File Format
Word (doc, docx)
Size: (34 KB)

Pregnancy Verification for out of Institution Births

pregnancy verification for out of institution births
File Format
Word (doc, docx)
Size: (30 KB)

FAQs (Frequently Asked Questions)


What can be used as evidence of pregnancy?

The pregnant woman may get a pregnancy verification letter from a licensed physician or hospital. As a witness, they will have to take a pregnancy test with the doctor or nurse. For verification, submit blood and urine samples in the hospital/clinic’s labs. When the pregnancy status is confirmed, the doctor will provide a signed statement declaring that the woman is pregnant. This acts as a legal evidence of pregnancy.

How do I show evidence of pregnancy for Medicaid?

We have mentioned above that a pregnancy verification letter is issued by a licensed physical or medical entity. This will act as enough evidence of pregnancy for Medicaid and for any other legal purpose.

Does Planned Parenthood provide evidence of pregnancy?

Planned Parenthood generally conducts free pregnancy tests. The doctor may agree to sign off on a proof of pregnancy form if they are present at the clinic. Bear in mind that a witness will be needed for such a form. It means, to get a proof of pregnancy verification letter, women may not take positive pregnancy tests that have been used earlier.

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