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Code Condition Criteria Assigned 6-12 months of age- Hgb (g): <11.0 12-23 months of age- Hgb (g): <11.0 24 months-5 years of age- Hgb (g): < 11.1 Child (12 months-5 years of age): HR: Hgb (g): < or = to 10.0 211 Pregnant BF, NBF Infant Child Elevated Blood Lead Levels > or = to 5 ug/dl within the past 12 months (documentation required) System Assigned 301 Pregnant Hyperemesis Gravidarum* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 302 Pregnant Gestational Diabetes* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned High-risk 303 Pregnant BF NBF History of Gestational Diabetes* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) P: any pregnancy; B, N; most recent pregnancy System or CPA Assigned High-risk 304 Pregnant BF NBF History of Preeclampsia* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 311 Pregnant BF NBF History of Preterm Delivery*: < or = to 36 6/7 weeks gestation P: any pregnancy; B, N: most recent pregnancy History of Early Term Delivery*: > or = to 37 and < or = 38 6/7 weeks gestation P: any pregnancy; B, N: most recent pregnancy (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 312 Pregnant BF NBF History of Low Birth Weight*: < or = to 5 lbs. 8 oz. (< or = to 2,500 g) P: any pregnancy; B, N: most recent pregnancy (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 321 Pregnant BF History of Spontaneous Abortion, Fetal or Neonatal Loss*: System or CPA Assigned Effective 8/2020