DSHS Form 10-489 Confidential Health Information Consent Agreement - Washington (Somali)

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 Somali. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 10-489?A: DSHS Form 10-489 is the Confidential Health Information Consent Agreement form in Washington.

Q: What is the purpose of DSHS Form 10-489?A: The purpose of DSHS Form 10-489 is to authorize the release and use of your confidential health information.

Q: Who needs to fill out DSHS Form 10-489?A: Anyone who wants to authorize the release and use of their confidential health information needs to fill out DSHS Form 10-489.

Q: Is DSHS Form 10-489 specific to Washington?A: Yes, DSHS Form 10-489 is specific to Washington.

Q: Is DSHS Form 10-489 available in Somali?A: Yes, DSHS Form 10-489 is available in Somali language.

Q: What should I do after filling out DSHS Form 10-489?A: After filling out DSHS Form 10-489, you should submit it to the appropriate healthcare provider or organization.

Q: Can I revoke my consent given through DSHS Form 10-489?A: Yes, you can revoke your consent at any time by submitting a written revocation to the healthcare provider or organization.

Q: Is there a fee to fill out DSHS Form 10-489?A: No, there is no fee to fill out DSHS Form 10-489.

Q: Can I get assistance in filling out DSHS Form 10-489?A: Yes, you can seek assistance from the healthcare provider or organization in filling out DSHS Form 10-489.

Q: Is DSHS Form 10-489 legally binding?A: Yes, once you sign DSHS Form 10-489, it becomes a legally binding agreement.

Q: What happens if I don't fill out DSHS Form 10-489?A: If you don't fill out DSHS Form 10-489, your confidential health information may not be released or used without your explicit consent.

Q: Can I withdraw my consent after filling out DSHS Form 10-489?A: Yes, you can withdraw your consent at any time by submitting a written revocation.

Q: Is DSHS Form 10-489 only for Somali-speaking individuals?A: No, DSHS Form 10-489 is available for anyone who needs to authorize the release and use of their confidential health information, including Somali-speaking individuals.