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DOH Form 611-006 Administrator Change Notification Form - Behavioral Health Agency Service Provider - Washington
What Is DOH Form 611-006?
This is a legal form that was released by the Washington State Department of Health - 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 the DOH Form 611-006?
A: The DOH Form 611-006 is the Administrator Change Notification Form.
Q: Who should use this form?
A: This form is used by Behavioral Health Agency Service Providers in Washington.
Q: What is the purpose of this form?
A: The purpose of this form is to notify the Department of Health of any changes in the administrator of a behavioral health agency.
Q: Are there any fees associated with submitting this form?
A: No, there are no fees associated with submitting this form.
Q: What information is required on the form?
A: The form requires information such as the agency name, current administrator, new administrator, effective date of the change, and contact information for the new administrator.
Form Details:
- Released on July 1, 2018;
- The latest edition provided by the Washington State Department of Health;
- 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 DOH Form 611-006 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.
