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Get and Sign Dshs 17 063 2016-2022 Form
(NOT REQUIRED)
AUTHORIZATION:
SOURCES: I authorize the following DSHS programs to disclose or give access to confidential information about me as described
below. Information may be provided verbally or by computer data transfer, mail, fax, or hand delivery.
The following programs only (check all that apply):
Behavioral Health and Recovery (DBHR)
Children’s Administration (CA)
Child Support (DCS)
Community Services (CSD – public assistance)
Developmental Disabilities (DDA)
Home and Community...
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