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How to fill out the N New - Dhs Wisconsin online
Filling out the N New - Dhs Wisconsin form online can be straightforward with the right guidance. This comprehensive guide will walk you through each section of the form to ensure you provide accurate information.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to access the N New - Dhs Wisconsin form and open it in your preferred editing tool.
- Begin by entering the W9 name, as it appears on your income tax return. This ensures that your information is accurate and matches official records.
- If your business name differs from the W9 name, provide the W9 business name in the designated field.
- Select the W9 business type that best describes your organization, such as individual/sole proprietor, corporation, partnership, LLC, or other.
- Indicate whether you are an exempt payee by selecting 'Y' for yes or 'N' for no.
- Enter your W9 TIN, which can be either your Social Security Number (SSN) or Employer Identification Number (EIN). This serves as your provider ID.
- List the billing provider's last name or ID, along with the organization name, ensuring accuracy in the qualifier section.
- Fill out the billing provider's first name and middle name, if applicable.
- Complete the billing provider's address information. You may use a P.O. Box if necessary.
- Provide the billing provider's city, state, and zip code, ensuring all contact details are precise.
- Include the billing provider's phone number formatted as 999-999-9999.
- Proceed to fill out the servicing provider details, repeating the previous steps for their name, address, and contact information. Ensure you enter a physical address, as P.O. Boxes are not accepted.
- Fill in the servicing provider's NPI and license number, along with the license expiration or renewal date and the state.
- Indicate the specialties of the provider, if applicable, by entering details for up to three specialties.
- Provide the provider start and end dates as required.
- Lastly, enter the contact name, phone number, and email address for further correspondence.
- After completing all sections of the form, remember to save your changes, and choose to download, print, or share the form as needed.
Complete the N New - Dhs Wisconsin form online with confidence today!
Office of Civil Rights (OCR) has confirmed that health information may be disclosed for treatment purposes to emergency medical transport personnel who will provide treatment to individuals while transporting patients to the emergency department. But even then, the information is limited under the law to only what is deemed minimum necessary. . Public health departments must also comply with state laws regarding confidentiality of information.
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