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Authorization Washington State Department of Social and Form

Authorization Washington State Department of Social and Form

Use a background check washington state dshs template to make your document workflow more streamlined.

Records I am authorized to access these records because I am the attach proof of Parent of minor Legal Guardian Personal or estate representative authority OFFICE USE ONLY DATE RECEIVED RECEIVED AT DATE ACKNOWLEDGED ID VERIFIED DATE RECORDS PRODUCED BY REQUEST FOR DSHS RECORDS DSHS 17-041 REV. Request for Records from these DSHS Program s Please check all that apply Behavioral Health Administration BHA Child Support DCS Developmental Disabilities DDA Vocational Rehabilitation DVR Special...
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