Forms
Confidential Information
Release Authorization HFS-9 (Rev. 04/03)
http://dhfs.wisconsin.gov/forms/HFSnum.asp
Wisconsin Medicaid Urgent Care Dental In-State Emergency Provider Data
Sheet HCF11013 (Rev. 01/04)
http://dhfs.wisconsin.gov/forms/DHCF/HCF11013.pdf
(PDF, 103 KB)
http://dhfs.wisconsin.gov/forms/dhcf/hcf11013.doc
(Word - Fillable)
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Last Revised: April 07, 2006
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