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CONSENT CONSIM M NT - dshs wa

CONSENT CONSIM M NT - dshs wa 2025

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The document is a consent form for clients of the Department of Social and Health Services (DSHS) in Romania, allowing the sharing of confidential personal information with various agencies and professionals to facilitate planning, treatment, and benefits. It outlines the client's rights regarding privacy, the types of information that can be shared, and the process for providing consent. The form also includes sections for client identification, specific authorizations for sharing sensitive data, and instructions for completion.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the CLIENT IDENTIFICATION section. Enter your NAME, DATE OF BIRTH, ADDRESS, CITY, PHONE NUMBER (including area code), STATE ID NUMBER, and ZIP CODE. Ensure all details are accurate for proper identification.
In the CONSENT section, indicate your agreement to share personal information with DSHS for planning and coordinating services. Check all applicable boxes for the agencies and individuals authorized to access your information.
Specify which types of data you consent to share by marking the relevant options such as medical care information or treatment plans. If any sensitive data is included, ensure you check those specific boxes.
Complete the SIGNATURE section by signing and dating the form. If applicable, have a parent or legal representative sign as well. Include their contact number if necessary.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is informed consent in Washington state?

Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment.

What is a consent order WA?

A consent order is a written agreement that is approved by a court. They are used when you have made an agreement and want the Court to turn it into formal orders, and dont need the Court to make the decisions for you.

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