This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin.
The document is provided in Hmong. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form F-03096H?
A: Form F-03096H is a document that authorizes the disclosure of information to the Wisconsin Department of Health Services for the Katie Beckett Medicaid program in Wisconsin (Hmong).
Q: What is the purpose of Form F-03096H?
A: The purpose of Form F-03096H is to grant permission for the disclosure of information to the Wisconsin Department of Health Services for the Katie Beckett Medicaid program in Wisconsin (Hmong).
Q: Who is Katie Beckett?
A: Katie Beckett is a Medicaid program that provides health care coverage for children with long-term disabilities or complex medical needs in Wisconsin.
Q: What is the Wisconsin Department of Health Services?
A: The Wisconsin Department of Health Services is the state agency responsible for promoting and protecting the health and well-being of the residents of Wisconsin.
Q: What is the Hmong language?
A: The Hmong language is a language spoken by the Hmong people, an ethnic group from Southeast Asia.
Q: What information can be disclosed with Form F-03096H?
A: Form F-03096H allows for the disclosure of information related to the Katie Beckett Medicaid program in Wisconsin (Hmong), such as medical records and financial information.
Q: Who needs to complete Form F-03096H?
A: Form F-03096H should be completed by individuals or parents/guardians of children who are applying for or receiving services through the Katie Beckett Medicaid program in Wisconsin (Hmong).
Form Details:
Download a fillable version of Form F-03096H by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.