Form HCA22-855 Health Home - Adolescent Information-Sharing Consent - Washington

What Is Form HCA22-855?

This is a legal form that was released by the Washington State Health Care Authority - 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 HCA22-855?
A: Form HCA22-855 is a Health Home - Adolescent Information-Sharing Consent form.

Q: What is the purpose of Form HCA22-855?
A: The purpose of Form HCA22-855 is to authorize the sharing of health information for adolescents receiving health home services.

Q: Who needs to fill out Form HCA22-855?
A: This form needs to be filled out by the parent or guardian of the adolescent. The adolescent may also be involved in the process.

Q: What information is required on Form HCA22-855?
A: Form HCA22-855 requires the name of the adolescent, the name and contact information of the parent or guardian, and the scope of authorized information sharing.