Get Wisconsin Dept Of Health Services Well Woman Program F 44724 Form
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How to fill out the Wisconsin Dept Of Health Services Well Woman Program F 44724 Form online
The Wisconsin Department of Health Services Well Woman Program F 44724 Form is essential for submitting breast cancer diagnostic and follow-up reports. This guide will provide step-by-step instructions on how to fill out the form efficiently and accurately online.
Follow the steps to complete the form online.
- Click ‘Get Form’ button to access the form and open it in the online editor.
- Begin with Section I, which requests billing provider information. Fill in the Provider ID, Name, Taxonomy Code, and Practice Location ZIP+4 Code.
- Next, move to Section II for member personal information. Provide the member's Last Name, First Name, Previous Last Name, Middle Initial, Member Identification Number, and Date of Birth.
- In Section III, provide details on breast diagnostic procedures. Start with additional mammographic views by entering the Date Performed and the Rendering Provider's Name, followed by selecting the appropriate Result.
- Continue filling out Section III with the film comparison details: enter the Date Performed, Rendering Provider’s Name, and select the Result from the provided options.
- Add information regarding breast consultations, fine needle aspirations, and biopsies by filling in the relevant dates, rendering provider names, and results.
- For each procedure, carefully check the Result options and provide any necessary notes or recommendations as prompted.
- Finalize the form by completing the final diagnosis section if applicable. Ensure that you select the appropriate status of final diagnosis and provide any additional required details.
- Once all sections are completed, review your inputs for accuracy. Save changes, download, print, or share the form as needed.
Complete your documents online today to ensure timely submission and follow-up.
If you received a bill for your mammogram, it may be due to your insurance coverage or the provider's billing practices. Sometimes, insurance plans require co-pays or deductibles that can lead to charges. If you participate in the Wisconsin Dept Of Health Services Well Woman Program F 44724 Form, ensure you understand the services covered. It's essential to review your plan details or contact your insurance for clarity.
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