Form HCA50-0142 Pebb Certification of a Child With a Disability - Washington

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Form HCA50-0142 Pebb Certification of a Child With a Disability - Washington

What Is Form HCA50-0142?

This is a legal form that was released by the Washington State Health Care Authority - 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 the form HCA50-0142?
A: The form HCA50-0142 is the Pebb Certification of a Child With a Disability form.

Q: What is the purpose of the form?
A: The form is used to certify a child with a disability for the purposes of the Pebb program in Washington.

Q: Who needs to complete the form?
A: The form needs to be completed by the child's parent or guardian.

Q: What information is required on the form?
A: The form requires information about the child's disability, medical history, and treatment.

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Form Details:

  • Released on February 1, 2022;
  • The latest edition provided by the Washington State Health Care Authority;
  • 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 fillable version of Form HCA50-0142 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.

Download Form HCA50-0142 Pebb Certification of a Child With a Disability - Washington

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