Get Wa Dshs 13-678 2021-2026

The WA DSHS 13-678 form, known as the Nurse Delegation: Consent for Delegation Process, is crucial for individuals involved in delegating nursing tasks. This guide will help you navigate the online filling process efficiently and accurately.

Follow the steps to complete your form online.

1. Press the ‘Get Form’ button to access the document and open it in your browser.
2. Fill out the client name field with the last name followed by the first name of the client.
3. Input the client's ACES Client ID Number for identification.
4. Provide the date of birth of the client in the format of month, day, and year.
5. If applicable, enter the ID setting which can include options like AFH, ALF, DDD Program, or In-home.
6. Complete the client address section with the street address, city, state, and ZIP code.
7. Input the telephone number where the client can be reached, including area code.
8. Identify the facility or program contact by entering their name, and select N/A if the client resides at home.
9. Provide a different telephone number for the facility contact if needed.
10. Enter a fax number at the facility if available.
11. Fill in the email address of the client or facility, if accessible.
12. Choose the appropriate setting by checking the relevant box.
13. List the client's diagnosis that may impact the delegation of tasks.
14. Detail any known allergies or indicate “N/A” if not applicable.
15. Enter the name of the client’s health care provider.
16. Provide the telephone number of the health care provider listed.
17. Have the client or authorized representative sign the form after explaining the delegation process.
18. Record their telephone number if it differs from the initial entry.
19. Document the date of the client's signature.
20. Indicate who provided verbal consent, ensuring they understand the process beforehand.
21. Enter the relationship of the individual granting consent to the client.
22. Document the date that verbal consent was obtained.
23. Print the name of the Registered Nurse Delegator.
24. Fill in the telephone number of the Registered Nurse Delegator.
25. Lastly, the Registered Nurse Delegator should sign and date the document to verify consent.
26. Review all entries for accuracy before proceeding to save, download, print, or share the completed form.

Complete your WA DSHS 13-678 form online today for efficient management of your nurse delegation process.