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  • Patient Review And Coordination Referral Form - Dshs - Dshs Wa

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Re. If you choose not to remain anonymous, please provide your name and phone number so one of our investigators may contact you if any additional information is needed. This form will be used for referring medical assistance clients who are in fee for service or managed care. If client is on managed care, the referral will be forwarded to the managed care plan. REFERRAL SOURCE CONTACT NAME BUSINESS ORGANIZATION LAST NAME TELEPHONE NUMBER FIRST NAME FAX NUMBER CLIENT NAME PIC NUMBER ADDR.

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You can turn in verification documents by mail, fax or drop off at your local office. Mail: DSHS Customer Service Center, PO Box 11699, Tacoma, WA 98411-9905 Fax: 888-338-7410 Please include your name and Client ID number or last four digits of your Social Security number on each page.

Mailing DSHS Community Services Division, P.O. Box 11699, Tacoma, WA 98411-6699. Faxing to 888-338-7410.

Mailing DSHS Community Services Division, P.O. Box 11699, Tacoma, WA 98411-6699. Faxing to 888-338-7410.

Look for a second email with subject line: “[SECURE] Email Documents to MyDocs@DSHS.WA.GOV” Then follow the steps in that message to attach and send your documents.

Latest News. Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232