DSHS Form 06-173 Medical Evidence Reimbursement - Washington

DSHS Form 06-173 Medical Evidence Reimbursement - Washington

What Is DSHS Form 06-173?

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.

FAQ

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.

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Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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.

Download DSHS Form 06-173 Medical Evidence Reimbursement - Washington

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