Get Wa Hca 13-967 2018-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the WA HCA 13-967 online
Filling out the WA HCA 13-967 form, also known as the opioid attestation form, is an important step in ensuring appropriate opioid prescription management for patients. This guide will provide clear, structured instructions to help you navigate the online filling process effectively.
Follow the steps to complete the WA HCA 13-967 form online.
- Click the ‘Get Form’ button to access the WA HCA 13-967 form and open it in the editor.
- Begin by filling in the patient details, including their full name and date of birth. Ensure the information is accurate and matches what is documented in the medical records.
- Next, enter the pharmacy's information, including the pharmacy name, their National Provider Identifier (NPI) if known, and their contact telephone and fax numbers.
- Proceed to provide the prescriber’s information. Enter the prescriber’s name, NPI, telephone number, and fax number accurately.
- List the prescribed medication along with its strength. Ensure all details are clear and check against the patient's prescription.
- Input the ProviderOne ID, if applicable. This number helps to identify the patient within the network.
- Include directions for medication use if known, specifying detailed instructions for the patient.
- Review the criteria for chronic opioid use carefully. Confirm that the requirements are met and mark either 'Yes' or 'No' in the appropriate section.
- Specify how long the attestation should be effective by entering a specific end date, if applicable. If no date is entered, the form will expire in 12 months.
- The prescriber must sign the form to certify that all information is accurate and meet legal requirements. Include the prescriber's specialty and the date of signing.
Complete your documents online to ensure efficient processing and compliance.
To contact your representative in Washington, you can visit the state legislature's website to find their contact information. This platform allows you to directly reach out via email or phone. Connecting with your representative can provide insights into topics like WA HCA 13-967 and help you voice your concerns or questions regarding healthcare. Engaging with your representative is a proactive way to ensure your needs are heard.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.