PDF
Word
DSHS Form 15-420 Request for Icf / Iid or Sonf Admission - Washington
What Is DSHS Form 15-420?
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 Form 15-420?
A: Form 15-420 is the Request for Icf/Iid or Sonf Admission form.
Q: What is ICF/IID?
A: ICF/IID stands for Intermediate Care Facility for Individuals with Intellectual Disabilities.
Q: What is SONF?
A: SONF stands for Specialized Outpatient Neurorehabilitation Facility.
Q: Who needs to fill out Form 15-420?
A: This form needs to be filled out by individuals or their legal representatives who are requesting admission to an ICF/IID or SONF in Washington.
Q: What information is required on Form 15-420?
A: The form requires information about the individual seeking admission, their medical condition, and their current living situation.
Q: What happens after submitting Form 15-420?
A: After submitting the form, DSHS will review the request and make a determination regarding the individual's eligibility for admission to an ICF/IID or SONF.
Q: Is there a fee for submitting Form 15-420?
A: No, there is no fee for submitting this form.
Form Details:
- Released on June 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;
- Fill out the form in our online filing application.
Download a printable version of DSHS Form 15-420 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 15-420 Request for Icf / Iid or Sonf Admission - Washington
1
2
