WI DHS F-00059 2016-2025 free printable template
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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F00059 (08/2016)STATE OF WISCONSIN Wis. Admin. Code ch. DHS 35-Page 1 of 16OUTPATIENT MENTAL HEALTH CLINIC INITIAL APPLICATION DHS 35 INSTRUCTIONS:
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How to fill out WI DHS F-00059
01
Download the WI DHS F-00059 form from the official website.
02
Read the instructions carefully before starting to fill out the form.
03
Enter your personal information such as name, address, and contact details in the designated fields.
04
Provide necessary details about the service or request you are applying for.
05
If applicable, complete any sections related to your medical or financial information.
06
Review all entered information for accuracy and completeness.
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Sign and date the form where indicated.
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Submit the form according to the instructions provided, which may include mailing or submitting electronically.
Who needs WI DHS F-00059?
01
Individuals seeking assistance or services from the Wisconsin Department of Health Services.
02
Providers, caretakers, or family members applying for services on behalf of someone else.
03
Persons needing to report changes in their circumstances that affect their eligibility for services.
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What is WI DHS F-00059?
WI DHS F-00059 is a Wisconsin Department of Health Services form used for reporting and managing specific health-related data.
Who is required to file WI DHS F-00059?
Individuals or organizations involved in health services that require reporting specific data to the Wisconsin Department of Health Services are required to file WI DHS F-00059.
How to fill out WI DHS F-00059?
To fill out WI DHS F-00059, carefully follow the instructions provided on the form, ensuring all required fields are completed accurately with the necessary information.
What is the purpose of WI DHS F-00059?
The purpose of WI DHS F-00059 is to collect and report pertinent health data that aids in public health surveillance, monitoring, and resource allocation.
What information must be reported on WI DHS F-00059?
The information that must be reported on WI DHS F-00059 may include demographic data, service details, health outcomes, and any other relevant health-related information as mandated by the Wisconsin Department of Health Services.
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