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Form F-11036 Prior Authorization / Intensive in-Home Treatment Attachment (Pa / Ita) - Wisconsin
What Is Form F-11036?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-11036?A: Form F-11036 is the Prior Authorization/Intensive in-Home Treatment Attachment (PA/ITA) form used in Wisconsin.
Q: What is the purpose of Form F-11036?A: The purpose of Form F-11036 is to request prior authorization for intensive in-home treatment services in Wisconsin.
Q: Who uses Form F-11036?A: Form F-11036 is used by healthcare providers or individuals seeking intensive in-home treatment services.
Q: What information is needed on Form F-11036?A: Form F-11036 requires information about the individual receiving services, the provider, the services requested, and supporting documentation.
Form Details:
- Released on December 1, 2019;
- 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-11036 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-11036 Prior Authorization / Intensive in-Home Treatment Attachment (Pa / Ita) - Wisconsin
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