Paperwork for OB/GYN

A note before you read

I am an internist, not an obstetrician, but we both have to do a lot of paperwork to help our patients. For this article, I researched what the forms discussed ask for and what the federal rules say, and I name the rule in each section.

The pregnancy accommodation letter (Pregnant Workers Fairness Act)

The Pregnant Workers Fairness Act (PWFA) took effect on June 27, 2023. It generally requires an employer with 15 or more employees to make a reasonable accommodation for a worker’s known limitation related to pregnancy, childbirth or a related medical condition, unless the change would cause the employer undue hardship. Examples are more breaks, a stool to sit on, no heavy lifting, or time off for prenatal visits. The limitation does not have to rise to the level of a disability under the Americans with Disabilities Act (ADA). The Equal Employment Opportunity Commission (EEOC)’s examples of related conditions include recovery from childbirth, miscarriage, postpartum depression and lactation, so a letter may be needed after delivery too. It can be a minor or episodic need, or simply the need to go to prenatal care, and the letter does not need the diagnosis.

My reading of the EEOC’s rule is that an employer may ask for documentation only when that is reasonable under the circumstances. When it is, the employer is limited to enough to confirm the limitation, that it is related to pregnancy, childbirth or a related condition, and the change needed at work, and it may not require a particular form. When a pregnant employee asks to carry water, take extra bathroom or food breaks, sit in a job that requires standing, or stand in a job that requires sitting, her own word is enough, and the employer should not ask for a note at all. The same goes for time and a place to pump. So when a letter is appropriate, I would describe the limitation or need, how long it is expected to last, and the change that could help, and leave the exact arrangement to the patient and the employer.

The rule: 29 C.F.R. § 1636.3(a), (j) and (l).

FMLA for pregnancy and prenatal care

Under the FMLA regulations, any time a patient is unable to work because of pregnancy, or goes to prenatal care, counts as a serious health condition, even if she does not see you during that particular absence. Severe morning sickness that keeps her home is the regulation’s own example. The form may be the Department of Labor’s WH-380-E or one from the employer, an insurer or a leave administrator. Nurse-midwives, nurse practitioners and physician assistants also count as health care providers under the FMLA regulations. For prenatal visits, I would give the dates or the expected schedule. For the time around delivery, I would give one continuous period, from when she stops working through the usual recovery, and a longer one only with the medical reason for it. For an episode that keeps her from working, such as severe nausea and vomiting, the form asks how often it is likely to happen and how long each episode is likely to last.

It may also help to know that the WH-380-E says the employer may not ask for a certification for leave to bond with a healthy newborn, so if a patient brings one for that, I would let her know. And the diagnosis is optional on the FMLA form. The WH-380-E walkthrough goes through it field by field.

The rule: 29 C.F.R. §§ 825.115(b) and (f), 825.120.

Short-term disability for pregnancy

Around delivery, a patient may also bring a short-term disability claim. The insurer sends its own Attending Physician Statement, and each carrier asks different questions, so I would read the one in front of me. Depending on the carrier, it may ask for the diagnosis, the first day of her last menstrual period, the expected or actual delivery date, the delivery method, complications, the date she stopped working, treatment, restrictions and when you expect her back at work. The insurer decides the benefit under its policy, and I would not reduce the statement to the delivery date alone. Her restrictions and when you expect them to change matter as much as the dates. The Attending Physician Statement guide covers the questions the carriers share.

State disability and paid leave forms in New York, New Jersey and D.C.

New York, New Jersey and D.C. each have state forms that can cover pregnancy, and they are not the same kind of program. New Jersey’s temporary disability claim (DS-1) has a Part C for you, which asks for the diagnosis, the estimated date of delivery, the delivery date once she has delivered, the type of delivery and any complications. New York’s disability benefits claim (DB-450) has a Part B for you, which asks whether the disability is related to pregnancy and for the delivery date. The District of Columbia’s paid leave program has a separate medical certification for paid prenatal leave (PFL-PMC), which asks when you first confirmed the pregnancy, the expected due date and the prenatal visit dates, and a medical leave certification (PFL-MMC) for her own condition.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms obstetricians and gynecologists are asked to complete, such as pregnancy accommodation letters, FMLA forms, insurers’ disability statements and state disability and paid leave forms, so you can fill them out more quickly and more confidently. You set up your information once on each computer you use. Then you answer one question at a time, and nothing goes on the form until you confirm it. Before you sign, it flags some problems, such as family history on an FMLA form. Then you review the completed form, and if everything looks correct, you sign it and you’re done.

Your patients’ information is encrypted on your own device with a passcode only you know, and none of it is sent to us or anyone else. Because we never receive it, there is no business associate agreement to sign with us. HIPAA still applies to how your office handles that computer, any copies you export, and the forms you print and sign. If you want to try it on a letter or form your office already sees, the free trial is the easiest way, and I hope using PatientPapers saves you and your staff some retyping.

Questions the office asks

Does a pregnancy accommodation letter under the Pregnant Workers Fairness Act need the diagnosis?

No. The limitation does not have to be a disability, and the letter does not need the diagnosis. My reading of the EEOC’s rule is that an employer may ask for documentation only when that is reasonable, and then only for enough to confirm the limitation, its relation to pregnancy, childbirth or a related condition, and the change needed at work.

Can a patient get FMLA for pregnancy and prenatal care?

Yes. Under the FMLA regulations, prenatal care and any time the patient is unable to work because of pregnancy count as a serious health condition, even if she does not see you during that absence.

Do I certify FMLA leave to bond with the baby?

No. The WH-380-E says the employer may not ask for a certification for leave to bond with a healthy newborn. Caring for a mother who cannot care for herself after delivery is different, and that is the WH-380-F, which PatientPapers fills.

What does a short-term disability form for pregnancy ask the doctor?

It depends on the carrier, because each insurer sends its own Attending Physician Statement. You may be asked for the diagnosis, the delivery dates, the delivery method, complications, treatment, work restrictions, the date she stopped working and when you expect her back.

Which state pregnancy forms does PatientPapers fill?

New Jersey’s DS-1, New York’s DB-450 and D.C.’s PFL-PMC and PFL-MMC.

Can my nurse or medical assistant fill in the form for me?

Yes. A provider can add staff such as a nurse or medical assistant, at no extra charge, and each one gets their own passcode. They can fill in the whole form and mark it ready for you, but only the certifying provider can sign it, so I would read what they entered before signing. Everything stays on one computer, so a simple setup is one laptop or tablet kept just for forms that staff and clinicians share. How staff help with forms is the practice’s to arrange and supervise.