Instructions for Form F-00212 Prior Authorization Intensive in-Home Mental Health / Substance Abuse Services Assessment and Recovery / Treatment Plan Attachment - Wisconsin

Instructions for Form F-00212 Prior Authorization Intensive in-Home Mental Health / Substance Abuse Services Assessment and Recovery / Treatment Plan Attachment - Wisconsin

This document contains official instructions for Form F-00212 , Prior Authorization Intensive in-Home Mental Health/Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-00212 is available for download through this link.

FAQ

Q: What is Form F-00212?
A: Form F-00212 is a prior authorization form for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: What is the purpose of Form F-00212?
A: The purpose of Form F-00212 is to request prior authorization for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: Who needs to complete Form F-00212?
A: Form F-00212 needs to be completed by the provider requesting prior authorization for intensive in-home mental health/substance abuse services assessment and recovery/treatment plan attachment in Wisconsin.

Q: What information do I need to include in Form F-00212?
A: Form F-00212 requires you to include detailed information about the individual's clinical status, treatment history, proposed services, and recovery/treatment plan.

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Instruction Details:

  • This 4-page document is available for download in PDF;
  • Actual and applicable for the current year;
  • Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the Wisconsin Department of Health Services.

Download Instructions for Form F-00212 Prior Authorization Intensive in-Home Mental Health / Substance Abuse Services Assessment and Recovery / Treatment Plan Attachment - Wisconsin

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