Washington State Health Care Authority Forms

This document provides information and resources for individuals transitioning from incarceration in the state of Washington. It aims to guide them in reintegrating into society and finding support and services to aid in their successful reentry.

This form is used for reporting incidents that occur in health homes in Washington state. It is used to document any unexpected events or occurrences that could impact the health and safety of individuals receiving services in health home programs.

This form is used for signing an agreement to pay for healthcare services in the state of Washington.

This Form is used for requesting botulinum toxin treatment in the state of Washington.

This form is used for family-initiated treatment administration in the state of Washington. It is used to document and authorize medical treatments requested by family members for their loved ones.

This form is used for applying to be a member of the Office of Recovery Partnerships (ORP) Steering Committee in Washington.

This form is used for medical respite care providers in Washington to provide attestation for their services.

This form is used for Medicaid beneficiaries in Washington to attest their eligibility for participating in a qualified clinical trial.

This form is used for enrolling in a Medicare supplement insurance plan offered by Premera Blue Cross in Washington state.

This form is used for making changes to the health insurance coverage of a retired Public Employees Benefits Board (PEBB) member in Washington.

This Form is used for cancelling supplemental life and AD&D insurance through MetLife in Washington for PEBB members.