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File inserted into Admin. Code 212011. May not be current beginning 1 month after insert date. For current Adm. Code see: http://docs.legis.wisconsin.gov/code/admin code 71 DEPARTMENT OF HEALTH SERVICES
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How to fill out dhs 120 - wisconsin
How to Fill Out DHS 120 - Wisconsin:
01
Obtain the DHS 120 form: You can typically find this form on the official website of the Wisconsin Department of Health Services (DHS) or by contacting your local DHS office.
02
Familiarize yourself with the instructions: Before beginning to fill out the DHS 120 form, it is crucial to thoroughly read and understand the accompanying instructions. This will ensure that you provide accurate and complete information.
03
Provide personal information: The form will require you to provide your personal details, such as your name, address, date of birth, and contact information. Fill in this section accurately to avoid any discrepancies.
04
Fill in your medical history: The DHS 120 form may ask you to provide information regarding your medical history, including any existing conditions, allergies, or current medications. Be thorough and specific when answering these questions.
05
Provide information about your healthcare provider: The form may require you to provide details about your primary care physician or healthcare provider. This may include their name, address, phone number, and other relevant information.
06
Disclose any additional information: The DHS 120 form may have sections where you can provide any additional information or comments related to your health or medical history. Fill in this section if you have anything important to share.
07
Review and sign the form: Before submitting the DHS 120 form, carefully review all the sections to ensure that you have completed it accurately and comprehensively. Once satisfied, sign the form at the designated space.
Who needs DHS 120 - Wisconsin?
01
Individuals seeking healthcare services: The DHS 120 form is typically required for individuals who are seeking healthcare services within the state of Wisconsin. This may include accessing certain programs or benefits operated by the DHS.
02
Applicants for public assistance programs: Individuals who are applying for public assistance programs in Wisconsin, such as Medicaid or BadgerCare Plus, may be required to fill out the DHS 120 form. This helps the DHS gather information relevant to the individual's healthcare eligibility.
03
Existing program participants: Individuals who are already enrolled in certain healthcare programs administered by the DHS might also need to fill out the DHS 120 form periodically. This allows the DHS to update and verify the individual's information to ensure continued eligibility.
Note: It is important to check the specific requirements and guidelines provided by the Wisconsin Department of Health Services or consult with a DHS representative to determine if you need to fill out the DHS 120 form in your particular situation.
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What is dhs 120 - wisconsin?
DHS 120 - Wisconsin is a form used by the Wisconsin Department of Health Services to collect information on various health and social service programs.
Who is required to file dhs 120 - wisconsin?
Certain providers, organizations, and individuals receiving funding or participating in programs overseen by the Wisconsin Department of Health Services may be required to file DHS 120.
How to fill out dhs 120 - wisconsin?
DHS 120 can be filled out online or manually by providing the requested information accurately and submitting it before the deadline.
What is the purpose of dhs 120 - wisconsin?
The purpose of DHS 120 is to collect data and information necessary for the operation and evaluation of health and social service programs in Wisconsin.
What information must be reported on dhs 120 - wisconsin?
The information that must be reported on DHS 120 may include program participation data, financial information, and other relevant details depending on the specific program or funding.
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