Instructions for Form F-10119 Temporary Enrollment for Family Planning Only Services - Wisconsin

Form F-10119 Temporary Enrollment for Family Planning Only Services - Sample - Wisconsin

This document contains official instructions for Form F-10119 , Temporary Enrollment for Family Planning Only Services - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-10119 is available for download through this link.

FAQ

Q: What is Form F-10119?
A: Form F-10119 is a document for temporary enrollment in family planning services in Wisconsin.

Q: Who is eligible to use Form F-10119?
A: Any Wisconsin resident who wants to receive family planning services but does not qualify for other healthcare programs.

Q: What services are covered under Form F-10119?
A: Form F-10119 covers family planning services such as birth control methods, reproductive counseling, and sexually transmitted infection testing.

Q: How long does the temporary enrollment last?
A: The temporary enrollment lasts for one year from the date of approval.

Q: How can I apply for temporary enrollment?
A: You can apply for temporary enrollment by completing and submitting Form F-10119 to your local county or tribal consortium agency.

Q: Is there a fee for temporary enrollment?
A: No, there is no fee for temporary enrollment in family planning services.

Q: Can I use Form F-10119 for other healthcare services?
A: No, Form F-10119 is only for temporary enrollment in family planning services, not for other healthcare needs.

Q: What will happen after my temporary enrollment expires?
A: After your temporary enrollment expires, you will need to reapply if you still need family planning services.

Q: Can I be denied temporary enrollment?
A: Temporary enrollment can be denied if you do not meet the eligibility criteria or fail to provide required documentation.