This version of the form is not currently in use and is provided for reference only. Download this version of Form HCA50-0142 for the current year.
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.
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.
Form Details:
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.