Form F-03096H Authorization to Disclose Information to the Wisconsin Department of Health Services Katie Beckett Medicaid - Wisconsin (Hmong)

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin.

The document is provided in Hmong. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F-03096H?A: Form F-03096H is a document that authorizes the disclosure of information to the Wisconsin Department of Health Services for the Katie Beckett Medicaid program in Wisconsin (Hmong).

Q: What is the purpose of Form F-03096H?A: The purpose of Form F-03096H is to grant permission for the disclosure of information to the Wisconsin Department of Health Services for the Katie Beckett Medicaid program in Wisconsin (Hmong).

Q: Who is Katie Beckett?A: Katie Beckett is a Medicaid program that provides health care coverage for children with long-term disabilities or complex medical needs in Wisconsin.

Q: What is the Wisconsin Department of Health Services?A: The Wisconsin Department of Health Services is the state agency responsible for promoting and protecting the health and well-being of the residents of Wisconsin.

Q: What is the Hmong language?A: The Hmong language is a language spoken by the Hmong people, an ethnic group from Southeast Asia.

Q: What information can be disclosed with Form F-03096H?A: Form F-03096H allows for the disclosure of information related to the Katie Beckett Medicaid program in Wisconsin (Hmong), such as medical records and financial information.

Q: Who needs to complete Form F-03096H?A: Form F-03096H should be completed by individuals or parents/guardians of children who are applying for or receiving services through the Katie Beckett Medicaid program in Wisconsin (Hmong).