Get Wa Dshs 17-041 2011

The WA DSHS 17-041 form, also known as the request for DSHS records, allows users to request access to various records held by the Washington State Department of Social and Health Services. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the WA DSHS 17-041 form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. In section A, provide your own information. Enter your last name, first name, and middle name. Fill in your title, if applicable, and the name of your organization or business. Include your mailing address, city, state, zip code, telephone number (with area code), fax number (with area code), and email address.
3. Move to section B to specify which DSHS programs you are requesting records from. Carefully check all relevant options such as Children’s Administration, Community Services, and Behavioral Health, among others.
4. In section C, provide the details of the client records you are requesting. Specify if you are requesting records for yourself or another individual. Include their last name, first name, middle name, date of birth, any former names, client identification number, and other identification number, if available. Additionally, indicate the dates and location of the service.
5. Clarify the specific client records you want by referencing either an attached list or detailing the records directly in the section provided. You can also specify any limitations on the records requested.
6. Section D allows you to request other types of DSHS records. Clearly describe the records you wish to access, including any licensing records and other details.
7. In section E, indicate how you would like to receive the records. Options include mail or arranging a time to inspect the records in person. Be aware that DSHS may charge for copies per the associated regulations.
8. Sign the form in the 'Requested by' section, date it, and ensure a witness or notary verifies your identity if required. If you are not the client, specify your authority to obtain the records and attach proof, if applicable.
9. Once you have completed all sections, review the entire form for accuracy. Save your changes, and utilize options to download, print, or share the completed form as necessary.

Complete your WA DSHS 17-041 form online today to access the records you need.