PDF
Word
Instructions for Form F-01012 Reimbursement Request for a Pasrr Level I Screen - Wisconsin
This document contains official instructions for Form F-01012 , Reimbursement Request for a Pasrr Level I Screen - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-01012 is available for download through this link.
FAQ
Q: What is Form F-01012?
A: Form F-01012 is a reimbursement request form for a Pasrr Level I Screen in Wisconsin.
Q: What is a Pasrr Level I Screen?
A: A Pasrr Level I Screen is a screening process to determine if an individual needs additional services or supports due to mental illness, developmental disability, or related conditions.
Q: Who can submit a reimbursement request using Form F-01012?
A: Providers who conducted the Pasrr Level I Screen can submit a reimbursement request using Form F-01012.
Q: What information is required on Form F-01012?
A: Form F-01012 requires information such as provider details, individual being screened details, and a detailed description of services provided.
Instruction Details:
- This 2-page document is available for download in PDF;
- Actual and applicable for the current year;
- Complete, printable, and free.
Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.
Download Instructions for Form F-01012 Reimbursement Request for a Pasrr Level I Screen - Wisconsin
1
2
