Washington State Health Care Authority Forms

This form is used for submitting a citizenship affidavit in the state of Washington.

This document is used in Washington to provide citizenship documentation and declare one's identity.

This form is used for recording contact information for Palauan residents of the Washington Cofa Islander Health Care program.

This form is used for providing an irrevocable burial fund provision for SSI related healthcare in the state of Washington.

This document is used for applying for an Irrevocable Provision for a Funeral Fund for Medical Care Related to SSI in Washington.

This form is used for selecting a healthcare provider in Washington.

This form is used for enrolling in the HCA Premium Payment Program in Washington.

This Form is used for requesting retroactive health care coverage under Magi Medicaid in Washington state.

This type of document is a Form HCA13-952, which is used for applying for retroactive medical coverage under the Magi Medicaid program in Washington. This form is written in Spanish.

This Form is used for documenting the revocable burial fund provision for SSI related healthcare in Washington.

This Form is used for a Provision Revocable Funeral Fund for SSI-related Medical Care - Washington.

This Form is used for completing a treatment questionnaire in Washington state.

This form is used for completing a treatment questionnaire for healthcare purposes in Washington State. The form is available in Korean language for individuals who prefer to fill it out in that language.

This form is used for completing a treatment questionnaire in the state of Washington for individuals who speak Lao.

This Form is used for completing a treatment questionnaire for healthcare purposes in Washington State. It is designed specifically for Somali-speaking individuals.

This form is used for parents or caregivers to request Washington Apple Health benefits for children in tribal foster care in Washington state.

This form is used for requesting Washington Apple Health coverage for children who are aging out of tribal foster care in Washington state.

This form is used for completing a treatment questionnaire in Washington State. It is specifically designed for individuals who speak Russian.

This form is used for attesting to the provision of Applied Behavioral Analysis (ABA) services in Washington.

This form is used for midwives in Washington to attest to their qualifications and credentials. It is a requirement for practicing as a midwife in the state.

This form is used for mental health professionals in Washington to attest their qualifications and comply with state regulations.

This Form is used for registering practitioners and obtaining endorsements in Washington state.

This form is used for nominating a final order to be published in Washington.

This form is used for Washington State PEBB retirees to make changes to their benefits.

This Form is used to attest the capacity of a Applied Behavioral Analysis (ABA) Day Program in Washington.

This form is used for providing general information for authorization in the state of Washington. It is necessary for certain processes or procedures that require authorization by the state.

This form is used for determining the level of support requirement for Applied Behavioral Analysis (ABA) services in Washington state.