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Click ‘Get Form’ to open the DSHS Records Request in the editor.
Begin by filling out your personal information in Section A. Include your name, title, organization (if applicable), mailing address, and contact details.
In Section B, check all relevant DSHS programs from which you are requesting records. This helps specify the nature of your request.
Proceed to Section C to provide details about the client whose records you are requesting. Fill in their name, date of birth, and any identification numbers.
Clearly specify the records you need in Section C. You can list limitations on the records requested if necessary.
If applicable, complete Section D for other types of DSHS records you may need, such as licensing or employment records.
Finally, review Section E regarding access to records and sign where indicated. Ensure you understand any fees associated with obtaining copies.
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How may an individual request a public record? | State
Email: DSHSPublicDisclosure@dshs.wa.gov. DSHS prefers that all public record requests be in writing on the request for DSHS records form, DSHS 17-041.Read more
You can use the Request for Records form or. Phone: (360) 902-8484. Email: DSHSPublicDisclosure@dshs.wa.gov requests are located in Chapter 388-01 WAC.
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