Form DOC13-109 Seriously Ill Notification - Washington

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form DOC13-109 for the current year.

Form DOC13-109 Seriously Ill Notification - Washington

What Is Form DOC13-109?

This is a legal form that was released by the Washington State Department of Corrections - 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 DOC13-109?
A: Form DOC13-109 is a Seriously Ill Notification form in the state of Washington.

Q: Who needs to fill out Form DOC13-109?
A: The Seriously Ill Notification form needs to be filled out by a seriously ill individual or their representative.

Q: What is the purpose of Form DOC13-109?
A: The purpose of Form DOC13-109 is to notify the Department of Health in Washington of an individual's serious illness.

Q: When should Form DOC13-109 be filed?
A: Form DOC13-109 should be filed as soon as possible after a serious illness is diagnosed.

Q: Is there a fee to file Form DOC13-109?
A: No, there is no fee to file Form DOC13-109.

Q: What information is required on Form DOC13-109?
A: Form DOC13-109 requires information such as the individual's name, address, and a description of the serious illness.

Q: What happens after Form DOC13-109 is filed?
A: Once Form DOC13-109 is filed, the Department of Health will be notified of the serious illness and may provide appropriate resources and support.

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Form Details:

  • Released on September 4, 2020;
  • The latest edition provided by the Washington State Department of Corrections;
  • 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 Form DOC13-109 by clicking the link below or browse more documents and templates provided by the Washington State Department of Corrections.

Download Form DOC13-109 Seriously Ill Notification - Washington

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  • Form DOC13-109 Seriously Ill Notification - Washington, Page 1
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