Get Wa Dshs 13-905 2019-2026

The WA DSHS 13-905 is the Autistic Disorder Confirmation form, which is essential for documenting autism diagnoses in alignment with state regulations. This guide will provide a clear and supportive approach to help you complete the form online effectively.

Follow the steps to fill out the WA DSHS 13-905 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the applicant's name in the designated field for identifying the person requiring the diagnosis documentation.
3. Input the applicant's date of birth, ensuring the format is accurate for proper identification.
4. Fill in the clinician's name. This must be someone qualified to complete the form, such as a board-certified neurologist, psychiatrist, or licensed psychologist.
5. Provide the date of the diagnostic report to confirm the timeline of the evaluation.
6. List two or more specific, current examples of qualitative impairments in social interactions experienced by the applicant.
7. Detail one or more specific, current examples of qualitative impairments in communication.
8. Describe one or more specific, current examples of impairment related to restricted, repetitive, and stereotypical patterns of behavior, interests, and activities.
9. Document any delays or abnormal functioning evident prior to age three in specified areas.
10. Ensure the clinician signs and dates the document to validate its authenticity.
11. Complete and provide the contact information for the worker receiving the document, including the mailing address, phone number, and fax number.
12. Once all fields are filled, you can save your changes, download the document, print it, or share the completed form as necessary.

Complete the WA DSHS 13-905 online to effectively document and confirm autism diagnoses.