Form F-03096BH Authorization to Disclose Information to the Wisconsin Department of Health Services Katie Beckett Medicaid: Clinic-Specific - Wisconsin (Hmong)

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.

FAQ

Q: What is Form F-03096BH?
A: Form F-03096BH is an authorization form to disclose information to the Wisconsin Department of Health Services, specifically for the Katie Beckett Medicaid program.

Q: What is the purpose of Form F-03096BH?
A: The purpose of Form F-03096BH is to allow the disclosure of information to the Wisconsin Department of Health Services for the Katie Beckett Medicaid program.

Q: Who is Katie Beckett Medicaid for?
A: Katie Beckett Medicaid is for children with disabilities or complex medical needs who would not typically be eligible for Medicaid due to their parents' income.

Q: Why do I need to authorize the disclosure of information?
A: Authorizing the disclosure of information allows the Wisconsin Department of Health Services to gather necessary information to determine eligibility for the Katie Beckett Medicaid program.

Q: Is this form specific to a clinic in Wisconsin?
A: Yes, this form is clinic-specific and is for use in Wisconsin healthcare clinics.

Q: Is this form available in Hmong language?
A: Yes, this form is available in Hmong language for individuals who prefer to use that language.