A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid
Important names and resources |
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Speech-Language Pathologist____________________________ |
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Telephone Number_____________________________________ |
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E-mail Address ________________________________________ |
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Durable Medical Equipment Provider________________________ |
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Telephone Number______________________________________ |
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E-mail Address_________________________________________ |
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Physician _____________________________________________ |
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Telephone Number______________________________________ |
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E-mail Address_________________________________________ |
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Other________________________________________________ |
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Telephone Number_____________________________________ |
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E-mail Address_________________________________________ |
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Other_________________________________________________ |
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Telephone Number______________________________________ |
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E-mail Address__________________________________________ |
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Report CompletedChecklist for obtaining Augmentative Communication Devices
through Wisconsin Medicaid
Department of Health Services
Division of Health Care Access and Accountability
P- 11065 (04/11)