New Jersey Statutes Title 30. Institutions and Agencies 30 § 4D-7y

An obstetrical provider, nurse midwife, or other licensed health care professional, approved as a provider under the Medicaid program established pursuant to P.L.1968, c. 413 (C.30:4D-1 et seq.), shall complete the Perinatal Risk Assessment form, as used by the Division of Medical Assistance and Health Services in the Department of Human Services, for each pregnant Medicaid recipient and for each individual eligible for Emergency Medical Services for Non-Qualified Aliens who receives prenatal care from the provider. The Perinatal Risk Assessment form shall be the uniform document used by all providers and Medicaid managed care plans. The form shall be completed by the provider during the first prenatal visit with the pregnant Medicaid recipient or other eligible individual and updated by the provider in the third trimester of the recipient or other eligible individual.