WIN Interpreter Request
Thank you for contacting us for your language services needs! Please provide a complete response to all questions in order for us to schedule your request properly and to provide a better service. You can also call us to 828-274-0950 to make a request or email to win@mywcms.org
Please enter the name of your facility:
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Name and phone number of the person filling out this request:
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Notification email (this email will receive status notifications for this request):
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Service type:
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Face to Face
Telephone Interpretation
Video Call
Language:
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Patient's full name:
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Patient's date of birth:
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Race
Please Select
American Indian or Alaska Native
Asian
Black/African American
Native Hawaiian
White
More than one race
Unreported
Ethnicity
Please Select
Hispanic
Non-Hispanic
Patient's contact phone number:
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Is this patient enrolled in Project Access? If yes, please enter enrollment ID number.
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Date of the appointment:
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Appointment Location:
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Time of the appointment:
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Duration of the appointment:
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Type of appointment: (please provide a brief description. Ex: Sick visit, Post-op follow up, etc.)
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Other comments (or video call link if applicable)
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Submit
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