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DSHS Form 10-489 Confidential Health Information Consent Agreement - Washington (Somali)
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington.
The document is provided in Somali. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 10-489?
A: DSHS Form 10-489 is the Confidential Health Information Consent Agreement form in Washington.
Q: What is the purpose of DSHS Form 10-489?
A: The purpose of DSHS Form 10-489 is to authorize the release and use of your confidential health information.
Q: Who needs to fill out DSHS Form 10-489?
A: Anyone who wants to authorize the release and use of their confidential health information needs to fill out DSHS Form 10-489.
Q: Is DSHS Form 10-489 specific to Washington?
A: Yes, DSHS Form 10-489 is specific to Washington.
Q: Is DSHS Form 10-489 available in Somali?
A: Yes, DSHS Form 10-489 is available in Somali language.
Q: What should I do after filling out DSHS Form 10-489?
A: After filling out DSHS Form 10-489, you should submit it to the appropriate healthcare provider or organization.
Q: Can I revoke my consent given through DSHS Form 10-489?
A: Yes, you can revoke your consent at any time by submitting a written revocation to the healthcare provider or organization.
Q: Is there a fee to fill out DSHS Form 10-489?
A: No, there is no fee to fill out DSHS Form 10-489.
Q: Can I get assistance in filling out DSHS Form 10-489?
A: Yes, you can seek assistance from the healthcare provider or organization in filling out DSHS Form 10-489.
Q: Is DSHS Form 10-489 legally binding?
A: Yes, once you sign DSHS Form 10-489, it becomes a legally binding agreement.
Q: What happens if I don't fill out DSHS Form 10-489?
A: If you don't fill out DSHS Form 10-489, your confidential health information may not be released or used without your explicit consent.
Q: Can I withdraw my consent after filling out DSHS Form 10-489?
A: Yes, you can withdraw your consent at any time by submitting a written revocation.
Q: Is DSHS Form 10-489 only for Somali-speaking individuals?
A: No, DSHS Form 10-489 is available for anyone who needs to authorize the release and use of their confidential health information, including Somali-speaking individuals.
Form Details:
- Released on April 1, 2019;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a printable version of DSHS Form 10-489 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
Download DSHS Form 10-489 Confidential Health Information Consent Agreement - Washington (Somali)
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