№ lp_1_2_20038
Year: 2025
Region / City: Wisconsin
Topic: Health Services
Document Type: Form
Organization: Department of Health Services, Division of Public Health
Author: Department of Health Services
Target Audience: Managed Care Organizations, IRIS Consultant Agencies, PACE Organizations, Bureau of Quality & Oversight
Period of Effectiveness: N/A
Approval Date: N/A
Amendment Date: N/A
Contextual Description: Form used by organizations to request disenrollment from the Family Care, PACE, Partnership, and IRIS programs in Wisconsin.
Price: 8 / 10 USD
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