PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form HCA50-0142
for the current year.
Form HCA50-0142 Pebb Certification of a Child With a Disability - Washington
What Is Form HCA50-0142?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the form HCA50-0142?A: The form HCA50-0142 is the Pebb Certification of a Child With a Disability form.
Q: What is the purpose of the form?A: The form is used to certify a child with a disability for the purposes of the Pebb program in Washington.
Q: Who needs to complete the form?A: The form needs to be completed by the child's parent or guardian.
Q: What information is required on the form?A: The form requires information about the child's disability, medical history, and treatment.
Form Details:
- Released on February 1, 2022;
- The latest edition provided by the Washington State Health Care Authority;
- 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 HCA50-0142 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form HCA50-0142 Pebb Certification of a Child With a Disability - Washington
1
2
3
4
5
6
