Get Wi Dcf-f-4070-e 2020-2026

Filling out the WI DCF-F-4070-E is a vital step in applying for the Wisconsin Works (W-2) program At Risk Pregnancy (ARP) placement. This guide provides clear, step-by-step instructions to assist users in completing this form accurately and effectively.

Follow the steps to successfully complete the WI DCF-F-4070-E online.

1. Click the ‘Get Form’ button to access the document and open it in your editing program.
2. Begin filling out the patient's full name in the designated field. Ensure the name is spelled correctly to prevent any issues with processing.
3. Next, enter the patient's birth date in the format of mm/dd/yyyy. This information is crucial for identifying the individual's records.
4. Input the due date of the patient in the specified field. Use the same mm/dd/yyyy format for consistency.
5. Indicate whether the patient has a high-risk pregnancy. Select 'Yes' or 'No' based on the physician's evaluation.
6. If 'Yes' was selected, provide detailed information regarding the cause of the high-risk pregnancy in the corresponding field.
7. Provide the start date for when the patient became unable to work due to the high-risk pregnancy. This may be recorded as a date prior to the form's signature date.
8. Include any additional comments from the patient’s physician in the comments section to provide further context.
9. Check the physician's specialty area and list any additional specialties if applicable.
10. Enter the physician's National Provider Identifier (NPI), office address, and contact information clearly.
11. The physician must print their name legibly and provide a signature. Include the date of signing to finalize the form.
12. Review all filled information for accuracy. Once confirmed, you can save changes, download, print, or share the completed form as needed.

Complete your documents online today to ensure timely processing of your application.