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How to fill out the WI DHS F-01164 online
The Wisconsin Department of Health Services Form F-01164 is a consent form for sterilization. This guide will help users navigate and complete the form effectively while ensuring all necessary information is provided in a clear and organized manner.
Follow the steps to accurately complete the form online.
- Press the ‘Get Form’ button to access the F-01164 online. This will open the form in your preferred document editor.
- Begin by filling out the section titled ‘Statement of Person Obtaining Consent.’ Here, enter the name of the individual who is providing consent and ensure that all required details about their understanding of the procedure are included.
- In the ‘Consent to Sterilization’ section, the person giving consent should clearly indicate their understanding of the nature of sterilization, including the permanence of the procedure and the benefits available to them regardless of their decision.
- Ensure the individual signs and dates the form, confirming that they acknowledge the information provided and are voluntarily choosing to proceed with the sterilization.
- Next, the ‘Physician’s Statement’ must be completed by the physician performing the procedure. They need to confirm the individual's age, competency, and provide details of the sterilization operation.
- If applicable, fill out the ‘Interpreter’s Statement’ section if an interpreter was involved in explaining the consent to the individual. The interpreter should provide their signature and date.
- At the end of the form, verify that all required sections are completed and sign the document where necessary. Once completed, users can save changes, download, print, or share the form.
Prepare your documents and fill out the WI DHS F-01164 online today.
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Get answers to your most pressing questions about US Legal Forms API.
What does the Wisconsin Department of Health Services do?
Wisconsin Department of Health Services. Protects and promotes the health and safety of the people of Wisconsin. The Wisconsin Department of Health Services oversees Medicaid and other health and social service programs.
What does the Wisconsin Department of Administration do?
The Department of Administration has several key functions: to help the governor develop and implement the state budget and to support other state agencies and their programs by offering services such as centralized purchasing and financial management.
What is the mission of the Wisconsin Department of health?
To protect and promote the health and safety of the people of Wisconsin.
What is the Wisconsin hotline number?
Simply dial 211 from your cell phone or landline anywhere in Wisconsin. If you cannot reach us through 211, call 877-947-2211.
What does Wisconsin DHS stand for?
About the Department of Health Services (DHS) | Wisconsin Department of Health Services. Skip to main content. Skip to main content. Official website of the State of Wisconsin. Here's how you know.
What is the phone number for State of Wisconsin benefits?
Q: Get help with State of Wisconsin benefits including BadgerCare and ForwardHealth? A: Visit ACCESS. For help with ACCESS, contact Wisconsin Department of Health Services Member Services at (800) 362-3002, or memberservices@wisconsin.gov.
How do I contact the Wisconsin Department of Health Services?
If you can't find what you are looking for, or if you need more information: Call the IRIS Call Center at 888-515-4747. Email the Wisconsin Department of Health Services (DHS) at DHSIRIS@wisconsin.gov.
How do I contact Wisconsin medical licensing?
Call 800-621-8335 for assistance. All DOs applying for licensure must request the AOA Official Osteopathic Physician Profile Report at https://.aoaprofiles.org/.
Who regulates hospitals in Wisconsin?
The Wisconsin Department of Health Services handles complaints against a number of health care facilities, such as hospitals and nursing homes, and also against non-credentialed health care providers such as nurses aids and home health aids and many others.
When can you get your tubes tied Wisconsin?
The member is at least 21 years old on the date the informed written consent is obtained. The member gives voluntary informed written consent for sterilization.
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