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Form HCA13-335 Release of Information (Roi) for Substance Use Disorder (Sud) Services - Washington (English / Russian)
What Is Form HCA13-335?
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 HCA13-335?
A: Form HCA13-335 is a Release of Information (ROI) form for Substance Use Disorder (SUD) services in Washington.
Q: What is the purpose of Form HCA13-335?
A: The purpose of Form HCA13-335 is to obtain consent from the individual receiving SUD services to release their information.
Q: Who can use Form HCA13-335?
A: Form HCA13-335 can be used by individuals receiving SUD services in Washington and their authorized representative.
Q: What is the language of Form HCA13-335?
A: Form HCA13-335 is available in both English and Russian.
Q: Is Form HCA13-335 required for all SUD services?
A: Yes, Form HCA13-335 is required for all SUD services in Washington.
Q: Can I submit Form HCA13-335 electronically?
A: Yes, Form HCA13-335 can be submitted electronically.
Q: What information is included in Form HCA13-335?
A: Form HCA13-335 includes information about the individual receiving SUD services, the authorized representative (if applicable), and the specific information to be released.
Q: Can I revoke my consent on Form HCA13-335?
A: Yes, an individual can revoke their consent at any time by completing a Revocation of Release of Information form.
Q: Are there any fees associated with Form HCA13-335?
A: No, there are no fees associated with Form HCA13-335.
Form Details:
- Released on March 1, 2016;
- The latest edition provided by the Washington State Health Care Authority;
- Easy to use and ready to print;
- Available in Somali;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HCA13-335 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
