The Wisconsin Physician's Report for Medication or Treatment and Request for Hearing is a form used by Wisconsin physicians to request a hearing when their patient wishes to contest a medication or treatment recommendation. This form includes the patient’s medical history, diagnosis, and the recommended medication or treatment plan. It also includes the physician’s signature and the date the report was completed. The form must be filed with the Wisconsin Department of Health Services within 30 days of the date it is completed. There are two types of Wisconsin Physician's Report for Medication or Treatment and Request for Hearing: Initial Report and Subsequent Report. The Initial Report is used when a physician has determined the patient’s condition requires medication or treatment and the patient has refused that medication or treatment. The Subsequent Report is used when a patient has already received a hearing but wishes to appeal the decision or when a physician has changed the recommended medication or treatment plan.
Wisconsin Physician's Report for Medication or Treatment and Request for Hearing
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Physician's Report for Medication or Treatment and Request for Hearing
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