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01. Edit your dshs 14 012 online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
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03. Share your form with others
Send dshs consent form via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out dshs consent form with our platform
- Click ‘Get Form’ to open the DSHS consent form in the editor.
- Begin by filling out the CLIENT IDENTIFICATION section. Enter your NAME, DATE OF BIRTH, ADDRESS, CITY, TELEPHONE NUMBER, IDENTIFICATION NUMBER, STATE, and ZIP CODE. Ensure all information is accurate for proper identification.
- In the CONSENT section, indicate your agreement to share confidential information by checking the appropriate boxes for agencies and individuals listed. Be sure to include any additional providers if necessary.
- Specify which records you authorize for sharing by checking all applicable boxes under 'I authorize and consent to sharing the following records and information.' This includes health care information and treatment plans.
- Complete the duration of consent by indicating whether it is valid for one year or until a specified date or event. Remember that you can revoke this consent at any time in writing.
- Finally, sign and date the form. If applicable, have a parent or representative sign as well. Ensure that all signatures are completed before submitting.
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