Get Wa Dshs 17-063 2016

Completing the WA DSHS 17-063 form online is a vital process for authorizing the disclosure of your confidential DSHS records. This guide will walk you through each section of the form, ensuring you understand what information is required and how to fill it out accurately.

Follow the steps to effectively complete the WA DSHS 17-063 online.

1. Press the ‘Get Form’ button to access the WA DSHS 17-063 form and open it for editing.
2. In the identification of subject of records section, provide the full name of the person whose records are being requested. This includes the first name, middle name, last name, and any former names.
3. Enter the date of birth of the person whose records are requested. This crucial information helps in accurately identifying the individual.
4. Fill in any additional optional information that may assist in locating records, such as the client identification number, other identification numbers, dates of service, and the location of service.
5. In the 'Disclose To' section, enter the recipient's information. This should include their full name, title, organization or business name (if applicable), and contact details such as address, telephone number, fax number, and email address.
6. While the reason for disclosure is not mandatory, it is recommended to provide it, especially for sensitive records related to drug and alcohol or mental health.
7. In the authorization section, indicate which DSHS programs you allow to disclose your records by checking all that apply, or select the option for all parts of DSHS.
8. Specify the type of records you authorize for disclosure. You may choose to disclose all records, or limit them to specific records by providing details in the spaces provided.
9. If applicable, check the boxes for any special records you wish to include, such as HIV/AIDS, mental health, or chemical dependency records.
10. Sign and date the authorization section. If you are signing on behalf of someone else, indicate your relationship and attach proof of authority if necessary.
11. Finally, make sure to save your changes, download the completed document, or print it for your records as needed.

Complete your WA DSHS 17-063 form online today to ensure your confidential information is handled correctly.