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DSHS Form 10-489 LA Confidential Health Information Consent Agreement - Washington (Lao)
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 Lao. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the DSHS Form 10-489?
A: DSHS Form 10-489 is a consent agreement for LA confidential health information in Washington.
Q: What does the form entail?
A: The form is a consent agreement for the sharing of LA confidential health information.
Q: Who needs to fill out this form?
A: Any individual who wishes to authorize the sharing of their LA confidential health information.
Q: Why would someone need to fill out this form?
A: Someone may need to fill out this form to grant consent for the sharing of their LA confidential health information.
Q: Is there a fee to fill out this form?
A: There is no fee to fill out this form.
Q: What is LA confidential health information?
A: LA confidential health information refers to personal health information that is protected by law and requires authorization for sharing.
Q: How long is the consent valid?
A: The consent is generally valid until the individual revokes it or it expires as specified in the form.
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 LA 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 LA Confidential Health Information Consent Agreement - Washington (Lao)
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