Instructions for Form F-00212 Prior Authorization Intensive in-Home Mental Health / Substance Abuse Services Assessment and Recovery / Treatment Plan Attachment - Wisconsin

Form F-00212 Prior Authorization Intensive in-Home Mental Health/Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment - Wisconsin

This document contains official instructions for Form F-00212 , Prior Authorization Intensive in-Home Mental Health/Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-00212 is available for download through this link.

FAQ

Q: What is Form F-00212?
A: Form F-00212 is a prior authorization form for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: What is the purpose of Form F-00212?
A: The purpose of Form F-00212 is to request prior authorization for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: Who needs to complete Form F-00212?
A: Form F-00212 needs to be completed by the provider requesting prior authorization for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: What information do I need to include in Form F-00212?
A: Form F-00212 requires you to include detailed information about the individual's clinical status, treatment history, proposed services, and recovery/treatment plan.