Fill and Sign Legal Forms and Templates

This form is used for acknowledging the receipt of hysterectomy information in the state of Wisconsin. It provides instructions on how to fill out and submit Form F-01160.

This document provides instructions for completing and submitting Form F-00281, which is used for prior authorization and preferred drug list for fentanyl mucosal agents in the state of Wisconsin.

This Form is used for obtaining prior authorization or preferred drug list (Pa/Pdl) for Proton Pump Inhibitor (Ppi) orally disintegrating tablets in Wisconsin. It provides instructions on how to complete the form and submit it for approval.

This form is used for certifying the need for emergency psychiatric or substance abuse admissions to hospital institutions for mental disease for members under age 21 in Wisconsin. It is also used for Medicaid determination after admission.

This form is used for completing the Child Care Coordination Family Questionnaire in Wisconsin. It provides instructions on how to fill out the form and what information is required.

This form is used for requesting a review of a member's prescription drug use in the Pharmacy Services Lock-In Program in Wisconsin.

This Form is used for submitting a request for prior authorization for hearing instrument and audiological services in Wisconsin. It provides instructions on how to fill out the form and what documentation is required.

This Form is used for updating program provider files for the Wisconsin AIDS Drug Assistance Program, Wisconsin Chronic Disease Program, and Wisconsin Well Woman Program in Wisconsin.

This form is used for requesting special handling of pharmacy services in the state of Wisconsin. It provides instructions on how to fill out and submit the Form F-13074 for specific pharmacy needs.

This Form is used for Home Health Agencies in Wisconsin to request a variance of the physician signature requirement for verbal orders during recertification.

This document is used for obtaining consent to release information from the Child Protective Services System Central Registry in Hawaii.

This form is used for training, experience, and preceptor attestation for authorized users of manual brachytherapy sources in Wisconsin.

This document is used for residency documentation for homeless individuals in the state of Wisconsin. It helps individuals without a permanent address establish their residency for certain services and benefits.

This Form is used for Quarterly Wage Report in Wisconsin.

This form is used for ordering transportation services under the Oregon Health Plan. It allows individuals to request transportation for medical appointments or other healthcare needs.

This form is used for American Indian/Alaska Native individuals to request a change in their enrollment status for the Oregon Health Plan in Oregon.

This form is used for documenting the five A's intervention record in Oregon's maternity case management program for smoking cessation.

This Form is used for conducting home and environmental assessments as part of maternity case management in the state of Oregon.

This form is used for local match leveraging in the Oregon Medical Assistance Program (MMAP). It helps leverage funds from local sources to support the program.

This Form is used for tracking and education purposes related to maternity case management in Oregon.

This form is used for conducting an initial assessment for maternity case management in the state of Oregon.

This form is used for notifying the Oregon Health Plan about a pregnancy. It is required for individuals who are enrolled in the plan and become pregnant.

This Form is used for filing a medical liability claim for law enforcement agencies in Oregon. It helps individuals seek compensation for medical expenses resulting from incidents involving law enforcement officers.

This form is used for filing a motion for an order of dismissal in the state of Washington. It is an optional form that may be used in certain situations.

This form is used for filing an order of dismissal in Washington state. It is optional to use.

This document is used for registering a business certificate in Westchester County, New York.

This Form is used for filing a child support complaint in Wisconsin.

This Form is used for filing a child support complaint in Wisconsin in the Hmong language.

This form is used for requesting abandoned funds in the state of Wisconsin.

This form is used for obtaining informed consent from parents for their child to be observed or tested by an outside agency at a licensed child care center in Wisconsin.

This form is used for follow-up notification regarding tuberculosis (TB) from another jurisdiction in Wisconsin. It helps facilitate the coordination of healthcare and tracking of TB cases across jurisdictions.

This form is used for conducting fire inspections at community-based residential facilities (CBRFs) in Wisconsin.

This Form is used for authorizing the release of confidential information in Wisconsin.

This form is used for updating the remaining deductible for Wisconsin Medicaid and BadgerCare Plus.

This Form is used for applying for an air pollution control permit for painting and coating operations in Wisconsin.

This Form is used for applying for an air pollution control permit for operating a boiler or furnace in the state of Wisconsin.