Get Wi Dhs F-1008 2008

The Wisconsin Department of Health Services F-1008 form is essential for members electing hospice benefits under Medicaid. This guide will provide clear, step-by-step instructions to help you fill out this form accurately and efficiently online.

Follow the steps to complete the WI DHS F-1008 effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing Section I, which is mandatory for all hospice members. Provide the member's name, ID, and the date the election form was signed. Mention the hospice name and its National Provider Identifier (NPI), along with the attending physician's name and NPI. Indicate whether the attending physician is employed by the hospice by selecting 'Yes' or 'No.'
3. If the member resides in a nursing home at the time of hospice election, complete Section II. Fill in the name and NPI of the nursing home, along with the level of care required. Ensure you understand that this section signifies the agreement between the hospice and nursing home for service provisions.
4. For members entering a nursing home after hospice admission, proceed to Section III and provide the nursing home's name, NPI, and the date of admission to the nursing home.
5. If applicable, complete Section IV for the revocation of hospice benefits. Enter the member ID, hospice NPI, date of signing the revocation form, attending physician's name, and their NPI. Again, indicate whether the attending physician is employed by the hospice.
6. After filling in all required fields, review the completed form for accuracy. Ensure all information is clear and correct before finalizing your submission.
7. Once the form is finalized, save any changes you've made. You can then download or print the form to submit it physically or share it electronically as needed.

Complete the WI DHS F-1008 form online today for timely processing of hospice benefits.