Form F 44729 – Fill Out and Use This PDF

Form F 44729 is an income tax document created by the Internal Revenue Service for those seeking to report their annual self-employment taxes. It allows business owners to report their total income or losses, deductions, and credits from their enterprises during any given taxation period. Furthermore, filers can also freely calculate economic gains and losses made from individual shareholder partnerships. Additionally, Form F 44729 provides crucial tax computation data needed to submit prior payments or receive a funding refund from taxable returns. When appropriately completed with exact yearly details of each respective business venture's financial performance, this form can provide critical overall financial intelligence about one’s budget and expenditure on such activities.

Form F 44729 PDF Details

Are you considering a career in law enforcement? If so, you'll need to complete Form F 44729, which is the personal history statement for law enforcement applicants. This form requires detailed information about your education, work experience, and other relevant qualifications. Completing this form accurately is critical, as it will be used to determine your suitability for a career in law enforcement. Make sure to include all of the relevant information, and ask your friends or family members if they can help you fill out any of the sections that are confusing or difficult to complete. The sooner you submit your form, the sooner you'll be able to start pursuing your dream career!

Question	Answer
Form Name	Form F 44729
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	WNL, wisconsin well woman program follow up report drf, CCYY, Condyloma

Form Preview Example

DEPARTMENT OF HEALTH SERVICES	STATE OF WISCONSIN
Division of Public Health	s. 255.075, Wis. Stats.
F-44729 (10/08)

WISCONSIN WELL WOMAN PROGRAM

CERVICAL CANCER DIAGNOSTIC AND FOLLOW-UP REPORT (DRF)

INSTRUCTIONS: Before completing this form, refer to the Cervical Cancer Diagnostic and Follow-Up Report (DRF), F-44729A. For reimbursement, send claim plus this completed form to Wisconsin Well Woman Program (WWWP), P.O. Box 6645, Madison, WI 53716-0645.

SECTION I — BILLING PROVIDER INFORMATION

1. Provider ID

2. Name — Billing Provider

3. Taxonomy Code

4. Practice Location ZIP+4 Code

SECTION II — MEMBER PERSONAL INFORMATION

5. Last Name — Member

6. First Name — Member

7. Middle Initial — Member

8. Previous Last Name — Member

9. Member Identification Number

10. Date of Birth (MM/DD/CCYY)

SECTION III — CERVICAL DIAGNOSTIC PROCEDURES

COLPOSCOPY WITH BIOPSY / ENDOCERVICAL CURETTAGE

COLPOSCOPY WITHOUT BIOPSY

11.

Procedure Performed (Check One Box Only)

21. Date Performed (MM/DD/CCYY)

Colposcopy with Biopsy

Endocervical Curettage

12.

Date Performed (MM/DD/CCYY)

22. Name — Rendering Provider (Print)

13.

Name — Rendering Provider (Print)

23. RESULT (Check One Box Only)

Negative (WNL)

14.

RESULT (Check One Box Only)

Other Abnormality

Negative (WNL)

Inflammation / Infection / HPV Changes

Other Non-malignant Abnormality (HPV, Condyloma)

Unsatisfactory

CIN 1 / Mild Dysplasia

CIN 2 / Moderate Dysplasia

CIN 3 / Severe Dysplasia / CIS

Invasive Squamous Cell Carcinoma

Adenocarcinoma

LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP)

COLD KNIFE CONE

15.

Date Performed (MM/DD/CCYY)

24. Date Performed (MM/DD/CCYY)

16.

Name — Rendering Provider (Print)

25. Name — Rendering Provider (Print)

17.

RESULT (Check One Box Only)

26. RESULT (Check One Box Only)

Negative (WNL)

Other Non-Malignant Abnormality (HPV, Condyloma)

CIN 1 / Mild Dysplasia

CIN 2 / Moderate Dysplasia

CIN 3 / Severe Dysplasia / CIS

Invasive Squamous Cell Carcinoma

Adenocarcinoma

ENDOMETRIAL BIOPSY

27. NOTES

18.Date Performed (MM/DD/CCYY)

19.Name — Rendering Provider (Print)

20.RESULT (Check One Box Only) Negative / Normal Endometrium Hyperplasia

Adenomatous Hyperplasia Atypical Adenomatous Hyperplasia Adenocarcinoma In-situ Adenocarcinoma

Shading indicates follow up required for WWWP.

28. RECOMMENDATION

Follow Routine Screening Schedule _______________________ Months

Short Term Follow up _________ Months

Further Diagnostic Work Up Treatment*

*Not covered by WWWP.

CONTINUED

CERVICAL CANCER DIAGNOSTIC AND FOLLOW UP REPORT (DRF)				Page 2 of 2
F-44729 (10/08)

SECTION III — CERVICAL DIAGNOSTIC PROCEDURES (CONTINUED)
29. STATUS OF FINAL DIAGNOSIS (Check One Box Only)
Complete*	Pending	Member Deceased	Lost to Follow up	Refused Work-up

*Must complete Element 30 (Final Diagnosis).

30.FINAL DIAGNOSIS (Required) Date (MM/DD/CCYY) ____________

Normal / Benign / Inflammation	HPV / Condyloma / Atypia		CIN I / Mild Dysplasia
CIN 2 / Moderate Dysplasia*	CIN 3 / Severe Dysplasia / CIS*		Invasive Cervical Cancer**
Adenocarcinoma of the cervix**	LSIL (Biopsy Diagnosis)		HSIL (Biopsy Diagnosis)*
*Complete Treatment Date and Treatment Status.		**Complete Treatment Date, Treatment Status, and Tumor Stage.
31. TUMOR STAGE (AJCC)
Stage I	Stage II		Stage III	Stage IV

32.TREATMENT STATUS — REQUIRED (Check One Box Only) Treatment Started

Refused by Member Lost to Follow up

Not Indicated / Not Needed Member Deceased

Alternative Treatment (e.g., homeopathic therapy, herbal medicine, etc.)

33.TREATMENT DATE (MM/DD/CCYY)

How to Edit Form F 44729 Online for Free

With the online editor for PDFs by FormsPal, you can easily complete or edit WNL here. The tool is constantly maintained by us, getting cool functions and growing to be greater. To get the ball rolling, take these simple steps:

Step 1: Open the PDF file inside our tool by pressing the "Get Form Button" at the top of this page.

Step 2: The tool enables you to modify PDF documents in a variety of ways. Transform it by adding personalized text, correct existing content, and place in a signature - all within several mouse clicks!

It's an easy task to finish the document following this practical tutorial! This is what you must do:

1. To start with, when completing the WNL, start out with the section that has the next blanks:

WWWP conclusion process clarified (stage 1)

2. Now that this part is done, you'll want to include the necessary specifics in RESULT Check One Box Only cid, ENDOMETRIAL BIOPSY, Date Performed MMDDCCYY Name, RESULT Check One Box Only cid, and RESULT Check One Box Only cid so that you can progress further.

WWWP conclusion process clarified (part 2)

It's very easy to make an error when completing your RESULT Check One Box Only cid, so you'll want to look again prior to when you submit it.

3. Completing RESULT Check One Box Only cid, and Continued is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

4. All set to begin working on this fourth portion! Here you have these cid Pending, cid Member Deceased, cid CIN Severe Dysplasia CIS, SECTION III CERVICAL DIAGNOSTIC, cid Stage II, cid Lost to Follow up, cid Refused Workup, cid CIN I Mild Dysplasia cid, Complete Treatment Date Treatment, cid Stage III, and cid Stage IV blanks to complete.

Step 3: Immediately after proofreading your entries, press "Done" and you are done and dusted! Join FormsPal right now and easily use WNL, ready for download. All alterations made by you are saved , which enables you to edit the form further as required. Here at FormsPal, we endeavor to be certain that all of your information is kept private.

Form F 44729 – Fill Out and Use This PDF

Form F 44729 PDF Details

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