This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is DSHS Form 06-173?
A: DSHS Form 06-173 is a form used for Medical Evidence Reimbursement in Washington.
Q: Who uses DSHS Form 06-173?
A: It is used by individuals in Washington who need to request reimbursement for medical expenses.
Q: What is the purpose of DSHS Form 06-173?
A: The form is used to request reimbursement for medical expenses that were paid out of pocket.
Q: What information is required on DSHS Form 06-173?
A: The form asks for personal information, details of the medical expenses, and documentation to support the reimbursement request.
Q: Are there any eligibility requirements for reimbursement?
A: Yes, eligibility requirements such as income limits and residency may apply. Refer to the instructions on the form or contact DSHS for more information.
Q: How long does it take to process the reimbursement request?
A: Processing times can vary, but it is recommended to allow several weeks for the request to be reviewed and processed.
Q: What should I do if I have questions or need assistance with DSHS Form 06-173?
A: If you have questions or need assistance, you can contact your local DSHS office or the DSHS customer service hotline for further guidance.
Form Details:
Download a printable version of DSHS Form 06-173 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.