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Form W-10 Inter-Agency Patient Referral Report - Connecticut
What Is Form W-10?
This is a legal form that was released by the Connecticut State Department of Social Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form W-10?A: Form W-10 is the Inter-Agency Patient Referral Report.
Q: What is the purpose of Form W-10?A: The purpose of Form W-10 is to report patient referrals between health care providers and agencies.
Q: Who uses Form W-10?A: Form W-10 is used by health care providers and agencies in Connecticut.
Q: Is Form W-10 specific to a certain location?A: Yes, Form W-10 is specific to Connecticut.
Q: Is there a deadline for filing Form W-10?A: Yes, there is a deadline for filing Form W-10. Please refer to the instructions on the form for the specific deadline.
Q: Are there any penalties for not filing Form W-10?A: There may be penalties for not filing Form W-10, so it's important to submit the form on time.
Q: What information is required on Form W-10?A: Form W-10 requires information about the referring health care provider, the receiving agency, and the patient being referred.
Q: Is Form W-10 confidential?A: Yes, the information provided on Form W-10 is treated as confidential and is used for healthcare purposes only.
Form Details:
- Released on February 1, 2023;
- The latest edition provided by the Connecticut State Department of Social 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 printable version of Form W-10 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Social Services.
Download Form W-10 Inter-Agency Patient Referral Report - Connecticut
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