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Get and Sign Forms You Might Need DSHS 2018-2022
DSHS may still share information about you to the extent allowed by law. If you have questions about how DSHS shares client confidential information or your privacy rights, please consult the DSHS Notice of Privacy Practices or ask the person giving you this form. CLIENT IDENTIFICATION: NAME DATE OF BIRTH ADDRESS IDENTIFICATION NUMBER CITY TELEPHONE NUMBER (INCLUDE AREA CODE) STATE ZIP CODE OTHER INFORMATION CONSENT: I consent to the use of confidential information about me within...Show details
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