01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
CLIENT DISCLOSURE INFORMATION - Washington State - dshs wa 2026
Here's how it works
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.
Definition & Meaning
The "Client Disclosure Information - Washington State - DSHS WA" document is a mandatory disclosure form required for counselors practicing in Washington State. This document is governed by RCW 18.19 and WAC 246-810, which outline the necessary information that counselors must provide to their clients. It includes crucial details about the counseling agency, the qualifications of the counselor, and the treatment costs, ensuring transparency and informed consent in the counseling process.
How to Use the Client Disclosure Information - Washington State - DSHS WA
To use the Client Disclosure Information form, a counselor must provide it to clients at the outset of their relationship. This ensures that clients are fully aware of the counselor's qualifications, billing practices, and their rights. Clients are required to sign the form to acknowledge receipt and understanding. This signed document is then kept as part of the client's records to verify compliance with state regulations.
Steps for Counselors:
- Present the form to clients during the first session.
- Go through each section, explaining the content and relevance.
- Answer any questions the client might have regarding the information.
- Ensure the client signs the form.
- Store a copy in the client’s file for future reference.
Steps to Complete the Client Disclosure Information - Washington State - DSHS WA
Completing the Client Disclosure Information form involves several key steps to ensure accuracy and compliance with Washington State laws.
Step-by-Step Process:
- Counselor Information: Enter the counselor's name, license number, and contact information.
- Agency Details: Provide the details of the counseling agency, including address and phone number.
- Treatment Costs: List the charges for different types of services offered and any payment policies.
- Client Rights: Outline client rights, including confidentiality and grievance procedures.
- Signatures: Obtain the client’s signature and date, indicating they have been informed and understand the disclosure.
Key Elements of the Client Disclosure Information - Washington State - DSHS WA
The form includes critical elements aimed at protecting both the client and the provider.
- Counselor Credentials: Detailed information on the counselor's qualifications and certifications.
- Cost of Services: Transparent breakdown of therapy costs and billing practices.
- Rights and Protections: Information on client rights and how to file a complaint against unprofessional conduct.
- Confidentiality Policy: Explanation of how client information will be handled and any limitations on confidentiality.
Legal Use of the Client Disclosure Information - Washington State - DSHS WA
Legally, counselors in Washington State are obligated to provide this form to every client. The law mandates transparency in the therapeutic relationship and protects clients by ensuring they are informed about important aspects of counseling services. Failure to provide or properly maintain records of the disclosure can result in disciplinary actions against the counselor.
State-Specific Rules for the Client Disclosure Information - Washington State - DSHS WA
In Washington State, specific rules govern the use of the Client Disclosure Information form, particularly within the Department of Social and Health Services (DSHS). These regulations ensure that all necessary disclosures are made to safeguard public health and trust in mental health services.
Washington State Specifics:
- Mandatory under RCW 18.19 for all licensed counselors.
- Tailored to include state-specific legal requirements for counselor-client relationships.
- Includes specific instructions on how to file complaints with the appropriate state boards.
Important Terms Related to Client Disclosure Information - Washington State - DSHS WA
Familiarizing oneself with relevant terms can help in understanding the disclosure process.
- RCW: Revised Code of Washington, referring to the laws governing professional conduct.
- WAC: Washington Administrative Code, outlining rules implementing the laws.
- DSHS: Department of Social and Health Services, a key agency in regulating health practices.
Examples of Using the Client Disclosure Information - Washington State - DSHS WA
Real-world examples help illustrate the practical application of the disclosure form.
- Scenario 1: A client is starting therapy and is presented with the form during their initial appointment. The counselor reviews it with the client, addressing costs and confidentiality, ensuring the client understands their rights.
- Scenario 2: In the case of a complaint, the client uses the information on the form to contact the appropriate regulatory board, demonstrating the form’s role in client protection.
Who Typically Uses the Client Disclosure Information - Washington State - DSHS WA
This form is commonly used by a variety of professionals within the mental health field.
Relevant Practitioners:
- Licensed counselors
- Therapists
- Social workers
- Psychologists
These practitioners use the form to maintain compliance with Washington State regulations and to support informed client engagement.
See more CLIENT DISCLOSURE INFORMATION - Washington State - dshs wa versions
We've got more versions of the CLIENT DISCLOSURE INFORMATION - Washington State - dshs wa form. Select the right CLIENT DISCLOSURE INFORMATION - Washington State - dshs wa version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2009 | 4 Satisfied (59 Votes) |
What is considered confidential client information?
Confidential Information means any information, technical data or know-how (whether disclosed before or after the date of this Agreement), including, but not limited to, information relating to business and product or service plans, financial projections, customer lists, business forecasts, sales and merchandising,
How do I request a public disclosure in Washington state?
Submitting a records request Requestors name, complete mailing address, phone, and fax number. Date the request is submitted. Complete description of the identifiable records requested (title, subject, date, policy, etc.) Date range of the requested records (e.g., January 1, 2023 - December 31, 2023).
What constitutes client confidential information?
Client confidentiality is the principle that an institution or individual should not reveal information about their clients to a third party without the consent of the client or a clear legal reason.
How do I submit documents to DSHS Washington state?
Look for a second email with subject line: [SECURE] Email Documents to MyDocs@DSHS.WA.GOV Then follow the steps in that message to attach and send your documents. In the future, you can respond to this email to send documents electronically, so you may want to store it in your email inbox.
Which element must be contained in a disclosure statement provided to a client in Washington state?
The disclosure information provided by the psychologist or licensed psychological associate, the receipt of which shall be acknowledged in writing by the psychologist or licensed psychological associate and client, shall include any relevant education and training, the therapeutic orientation of the practice, the
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
People also ask
What constitutes confidential information about a customer?
Confidential client information can include various types of data, such as: Personal information: This includes the clients name, address, contact details, Social Security number, date of birth, and other personally identifiable information (PII).
Related links
You may make a public disclosure request to any DSHS office. You should ask to contact the Public Records Coordinator appointed for that office. records from
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