Get Wc12 Form

The Wc12 Form is a crucial document for individuals reporting changes in their developmental disabilities services. This guide provides straightforward instructions on how to complete the form online, ensuring that all necessary information is accurately submitted.

Follow the steps to complete the Wc12 Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the individual information section with the person's first name, middle name/initial, and last name. Ensure that these details are accurate to avoid processing delays.
3. Enter the Medical Assistance Number and Social Security Number. These identifiers are important for the processing of the waiver.
4. Indicate the jurisdiction or county in the specified field. This information assists in identifying the appropriate service area.
5. If there is a change of residential or day provider, select the appropriate checkbox and enter the names of the current and new providers, along with the change of site address if applicable.
6. Record the date of change and specify the type of services being updated, listing both the previous service and the new service.
7. If there has been a change in the Resource Coordination Agency, check the corresponding box and provide the names and addresses of both the previous and new agency.
8. For any admissions to nursing or chronic rehabilitation facilities, fill in the facility name, admission date and time, and discharge date and time, if applicable.
9. Complete the form by providing your name, agency (if applicable), and the date the form is completed.
10. Once all sections are filled out accurately, save any changes made, and proceed to download, print, or share the form as required.

Complete your Wc12 Form online today for a seamless processing experience.