DSHS Form 13-712 Personal Care Authorization (Bho / Mco) - Washington

What Is DSHS Form 13-712?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 13-712?
A: DSHS Form 13-712 is the Personal Care Authorization form.

Q: What does the form authorize?
A: The form authorizes personal care services under the Behavioral Health Organization (BHO) or Managed Care Organization (MCO) in Washington.

Q: Who is eligible to use this form?
A: Individuals who are receiving personal care services through a BHO or MCO in Washington are eligible to use this form.

Q: Do I need to submit this form for personal care services?
A: Yes, this form needs to be submitted in order to authorize and receive personal care services through a BHO or MCO in Washington.

Q: What information is required on the form?
A: The form requires personal information of the individual, their medical condition, and details of the authorized personal care provider.

Q: Are there any fees associated with this form?
A: There are no fees associated with completing and submitting DSHS Form 13-712.

Q: Can I modify or withdraw the authorization?
A: Yes, you can modify or withdraw the authorization by submitting a new form to the BHO or MCO.

Q: What should I do if I have questions about the form?
A: You should contact the Behavioral Health Organization (BHO) or Managed Care Organization (MCO) for assistance with any questions about the form.