Get Dshs Consent Form

Filling out the DSHS Consent Form online is an essential step for individuals seeking to authorize the sharing of their confidential information for service coordination and treatment. This guide will provide clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the DSHS Consent Form online.

1. Click the ‘Get Form’ button to obtain the DSHS Consent Form and open it in your preferred document editor.
2. Begin by entering your personal identification details in the 'Client Identification' section. Fill in the following fields: Name, Date of Birth, Address, Identification Number, City, Telephone Number, State, and Zip Code. Ensure accuracy to avoid any identification issues.
3. In the 'Consent' section, you will need to indicate your approval for DSHS to share your confidential information with various agencies. Check all applicable boxes to include relevant health care providers, mental health care providers, and any other organizations you authorize for information sharing.
4. Specify the records that you consent to share. You have the option to share all records, records listed on an attached list, or only select specific records. Clearly indicate your choices by checking the appropriate boxes.
5. If your records include sensitive information such as mental health or HIV/AIDS records, check the corresponding boxes to provide permission for those records to be shared. You must explicitly give consent for this type of information.
6. Indicate the duration of your consent by selecting either one year or specifying a date or event after which the consent will no longer be valid.
7. Review the 'Understanding' section carefully to ensure you comprehend what you are consenting to. It is crucial to ensure that you understand how your information will be used and shared.
8. Sign the form in the designated 'Signature' section, including the date of your signature. If applicable, a witness or agency contact should also sign the form.
9. If you are a parent, legal guardian, or representative signing on behalf of someone else, provide your signature in the appropriate section and include the required additional information.
10. Once the form is fully completed, save your changes. You can then download, print, or share the DSHS Consent Form as needed.

Complete your DSHS Consent Form online today to ensure your information is shared appropriately.