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STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-10095 (07/08) AST MEDICAID ASSET ASSESSMENT MEDICAL INSTITUTION / COMMUNITY WAIVER RESIDENT AND

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What is f-10095 - dhs wisconsin?

The f-10095 form is a tool used by the Wisconsin Department of Health Services (DHS) for reporting information related to healthcare services.

Who is required to file f-10095 - dhs wisconsin?

Healthcare providers and facilities that provide services in Wisconsin are required to file the f-10095 form.

How to fill out f-10095 - dhs wisconsin?

The f-10095 form can be filled out online through the Wisconsin DHS website or submitted by mail using the instructions provided.

What is the purpose of f-10095 - dhs wisconsin?

The purpose of the f-10095 form is to collect data on healthcare services provided in Wisconsin for program planning and evaluation purposes.

What information must be reported on f-10095 - dhs wisconsin?

Providers must report information such as the type of services provided, number of patients served, and payment received for services.

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