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Wisconsin Physicians Service Insurance Corporation 1717 W. Broadway P.O. Box 8190 Madison, WI 537088190 6089775000Autism Attestation Notification Name:Individual NPI:Degree:Title:License State:License
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Here are the steps to fill out autism attestation notification: 1. Start by downloading the autism attestation notification form from the official website.
02
Fill in your personal details such as name, contact information, and address.
03
Provide information about the individual with autism, including their name, date of birth, and relationship to you.
04
Write a detailed description of the individual's autism diagnosis, including the date of diagnosis and the name of the diagnosing physician.
05
Attach any supporting documents, such as medical reports or evaluations, that confirm the autism diagnosis.
06
Sign and date the form to certify that the information provided is accurate and complete.
07
Submit the filled-out form and supporting documents to the relevant authority or organization as specified in the instructions.

Who needs autism attestation notification?

01
Anyone who has a family member or a dependent with autism and needs to provide proof or notification of their condition may need to fill out an autism attestation notification. This could include parents, legal guardians, or caregivers of individuals with autism.
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The autism attestation notification is a formal document that individuals or organizations must submit to confirm compliance with laws and regulations pertaining to autism services or education.
Typically, service providers, educational institutions, and agencies that provide services to individuals with autism are required to file the autism attestation notification.
To fill out the autism attestation notification, you need to provide required information such as the organization's details, the nature of services provided, and confirm compliance with relevant regulations.
The purpose of the autism attestation notification is to ensure that entities providing services to individuals with autism adhere to established standards and regulations, promoting service quality and accountability.
The notification must typically report information including the organization’s name, address, a statement of compliance, and details regarding services provided to individuals with autism.
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