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Get Wi F-11278 2012-2025
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How to fill out the WI F-11278 online
The Wisconsin F-11278 form is crucial for agencies seeking certification to provide prenatal care coordination services. This guide will help users navigate the online filling process efficiently and accurately.
Follow the steps to complete the WI F-11278 online.
- Click the ‘Get Form’ button to obtain the form and open it in the online editor.
- In Section I, provide your agency's identification information. Identify the applicable category for your agency by checking all that apply.
- Enter the agency name, address, and telephone number. Also, provide the name of the agency director and their signature along with the date signed.
- Categorize your agency as either public or private and indicate the primary delivery model by checking the relevant box.
- In Section II, outline your outreach and management plan. Describe your target population and the geographic area you will serve.
- Detail your outreach efforts and techniques for finding eligible pregnant women and informing the community about available PNCC services.
- List appropriate community resources by providing their names, addresses, and telephone numbers.
- Indicate if you have a memorandum of understanding with Medicaid-certified HMOs in your county, and explain if you do not.
- Provide names and details of Medicaid-certified primary health care providers with whom you have referral arrangements.
- Demonstrate your agency’s cultural competence and describe how you will arrange for supportive services in the community.
- Describe the agency’s experience working with pregnant women and answering yes or no to Medicaid certification requirements.
- List program staff names and titles, and attach their resumes for those listed.
- Once all sections are filled out, save changes, download, print, or share the completed form as required.
Complete your documentation online to ensure a seamless process in obtaining certification for prenatal care coordination.
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