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Form F-03096B Authorization to Disclose Information to the Wisconsin Department of Health Services Katie Beckett Medicaid: Clinic-Specific - Wisconsin
What Is Form F-03096B?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F-03096B?
A: Form F-03096B is an Authorization to Disclose Information to the Wisconsin Department of Health Services.
Q: Who can use Form F-03096B?
A: Anyone who needs to authorize the disclosure of information to the Wisconsin Department of Health Services for Katie Beckett Medicaid.
Q: What is Katie Beckett Medicaid?
A: Katie Beckett Medicaid is a program in Wisconsin that provides health coverage for children with disabilities or long-term illnesses.
Q: What is the purpose of Form F-03096B?
A: The purpose of Form F-03096B is to grant permission to disclose information regarding an individual's eligibility for Katie Beckett Medicaid.
Q: Is Form F-03096B specific to a certain clinic in Wisconsin?
A: Yes, Form F-03096B is clinic-specific, which means it is intended to authorize the disclosure of information to a specific clinic in Wisconsin.
Form Details:
- Released on May 1, 2023;
- The latest edition provided by the Wisconsin Department of Health Services;
- 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 F-03096B by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-03096B Authorization to Disclose Information to the Wisconsin Department of Health Services Katie Beckett Medicaid: Clinic-Specific - Wisconsin
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