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Dshs ita form 2026
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- Click ‘Get Form’ to open the dshs ita form in the editor.
- Begin by entering the client’s name in the designated fields for last, first, and middle initial. Ensure accuracy as this is crucial for identification.
- Fill in the address section. If the client is homeless or transient, check the appropriate boxes provided.
- Input the city and Washington county of residence. If applicable, include the Provider One Client ID.
- Enter the date of birth and social security number carefully to maintain confidentiality and compliance.
- Select the gender of the client and provide details about their detention, including the name of the Evaluation & Treatment facility and dates of detention and release.
- Complete the ITA provider information by filling in their name, title, telephone number, and signature before submitting.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.6 Satisfied (66 Votes) |
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