Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out dshs 17 063 with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
Click ‘Get Form’ to open the dshs 17 063 in the editor.
Begin by filling out the 'Identification of Subject of Records' section. Enter your full name, date of birth, and any former names if applicable. This information helps locate your records.
In the 'Person Receiving Records' section, provide the full details of the individual or organization you are authorizing to receive your records, including their name, title, and contact information.
Next, move to the 'Authorization' section. Check all relevant DSHS programs that may disclose your records. If you want to limit disclosure to specific records, indicate this clearly.
If applicable, check any special records that require additional permission for disclosure such as HIV/AIDS or mental health records.
Finally, sign and date the form at the bottom. If signing on behalf of someone else, include proof of authority.
Start using our platform today for free to streamline your document editing and form completion!
Meet Our Leadership Cheryl Strange Acting Secretary of DSHS Lisa Yanagida Chief of Staff Amber Leaders Special Assistant to the Secretary Soumam Debgupta Chief Technology Information Officer and Assistant Secretary Technology Innovation6 more rows
How to apply for DSHS benefits in Washington?
You may complete an online application by using the WashingtonConnection.org website, applying by phone at 877-501-2233 or going to your local Community Services Office. On WashingtonConnection.org you can: Start a new application. Report a change, such as address, income or family situation.
Who is the head of the Washington State Department of Transportation?
Incoming Washington State Governor Bob Ferguson (D) has appointed Julie Meredith (above) to be secretary of the Washington State Department of Transportation effective January 15. She replaces Roger Millar, who is stepping down after serving as WSDOT secretary for nine years.
Who is the head of DCYF in Washington state?
Governor-elect Ferguson Announces New Department of Children, Youth, and Families Director. State Representative Tana Senn (D-Mercer Island) will serve as the next Director for the Department of Children, Youth, and Families (DCYF). The mission of DCYF is to ensure that all Washington youth grow up safe and healthy.
Who is the head of the HCA in Washington state?
Email MaryAnne. Appointed by Governor Ferguson in January 2025, MaryAnne Lindeblad serves as HCAs interim director, bringing decades of leadership and expertise to Washingtons largest health care purchaser.
Related Searches
Dshs 17 063 pdfDshs 17 063 formDSHS 27 081DSHS 27 222DSHS award letter onlineDSHS form 16-029Dshs change of address formDSHS Vital Statistics forms
Related forms
Request for Alberta Student Number Former students students complete these forms to receive their AS
What is the DSHS stop work form for Washington state?
Stop Work Questionnaire (form 14-438) This form is used when you stop work or self employment. The form should be signed by you but must be completed by your employer. Your employer can also complete this form On-Line.
What is the phone number for DSHS food stamps in Washington state?
Services are available at your local Community Services Office and by phone through the Customer Service Contact Center at 877-501-2233: TTY/TDD users dial 1-800-833-6384 for Washington Relay Service. Complete interviews for cash or food (application/eligibility review/mid-certification review).
Who is the head of the DNR in Washington state?
Managed by Commissioner Dave Upthegrove, DNR oversees 5.6M acres of state lands.
Related links
Wash. Admin. Code 388-880-151 - Requests for resident
DSHS Form 17-063 (Authorization to Disclose Records);. (iv) A clear statement on the first page of the request indicating that the requester is asking for a
The PUDF contains patient-level information for inpatient hospital stays. These data are extracted from DSHSs Hospital Discharge Database (HDD). The 2010 PUDF
Cookie consent notice
This site uses cookies to enhance site navigation and personalize your experience.
By using this site you agree to our use of cookies as described in our Privacy Notice.
You can modify your selections by visiting our Cookie and Advertising Notice.
