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235709

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This document is used in Wisconsin for providing written prior notice when no evaluation is recommended.

This form is used for applying for the Comprehensive Community Services (CCS) program in Wisconsin. It is specifically for individuals with mental disorders and substance use disorders. The form is a supplemental application for the Regional Model of CCS.

This form is used for creating a Supported Decision-Making Agreement in the state of Wisconsin.

This Form is used for a general pediatric clinic visit for a 15-month-old child in Wisconsin. It is a standard form that helps doctors and healthcare providers gather important information about the child's health and development at this specific age.

This Form is used for providing certification statements related to abortion in the state of Wisconsin. It is required to ensure compliance with the state's abortion laws.

Este formulario se utiliza para informar sobre los cambios en la cobertura de Medicaid en Wisconsin.

This form is used for printing client transfer labels in Wisconsin. It helps businesses in managing and organizing client information during the transfer process.

This form is used for submitting a prior authorization request for intensive in-home treatment in Wisconsin.

This type of document is a "Formulario F-02031 Solicitud Inicial Para Trabajos Con Plomo - Certificacion Individual" which is used for requesting initial certification to work with lead in Wisconsin.

This form is used for children under 18 years of age in Wisconsin to provide a statement of identity. It is available in Pashto language.

This form is used for parents or legal guardians in Wisconsin to provide a statement of identity for children under 18 years of age who speak Dari.

This document is used for determining participant eligibility for a program in Wisconsin. It provides information about whether or not an individual qualifies for the program.

This Form is used for applying for initial certification for emergency outpatient services in the state of Wisconsin.

This form is used for gathering information about a pregnant woman's medical history, current pregnancy, and any potential risk factors. It is specifically designed for use in Wisconsin.

This form is used for obtaining prior authorization or preferred drug list (Pa/Pdl) for non-steroidal anti-inflammatory drugs (NSAIDs) in the state of Wisconsin.

This Form is used for applying for Seniorcare program in Wisconsin for Hmong-speaking individuals. It provides instructions on filling out the application.

This Form is used for submitting a prior authorization drug attachment for non-preferred stimulants and related wake-promoting agents in Wisconsin's ForwardHealth program. It provides instructions on how to complete the form and submit it for approval.

This form is used for providing prior authorization and therapy attachment in the state of Wisconsin.

This form is used for recording the food consumption of children aged 1-12 in the state of Wisconsin.

This form is used for requesting prior authorization for hypoglycemic medications known as Glucagon-like Peptide (GLP-1) agents in the state of Wisconsin.

This document is a checklist for the SSI-E Natural Residential Setting application in Wisconsin. It includes all the required forms and documentation needed to apply for this program.

This form is used for requesting a waiver of physical therapist assistant and occupational therapy assistant supervision requirements in Wisconsin.

This form is used for applying for a radioactive material license in Wisconsin to use sealed sources in portable gauges or XRF devices.

This type of document is used for registering the nutrition of children (1 to 12 years old) in Wisconsin. (Spanish)

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

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