DSHS Form 10-673 Request for Icf / Iid or Nf Services at an Rhc Admission Application - Washington

DSHS Form 10-673 Request for Icf / Iid or Nf Services at an Rhc Admission Application - Washington

What Is DSHS Form 10-673?

This is a legal form that was released by the Washington State Department of Social and Health Services - 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 DSHS Form 10-673?A: DSHS Form 10-673 is a form used to request ICF/IID or NF services at an RHC admission application in Washington.

Q: What does ICF/IID stand for?A: ICF/IID stands for Intermediate Care Facility for Individuals with Intellectual Disabilities.

Q: What does NF stand for?A: NF stands for Nursing Facility.

Q: What is an RHC?A: RHC stands for Rural Health Clinic.

Q: What services can be requested on DSHS Form 10-673?A: ICF/IID or NF services can be requested on DSHS Form 10-673.

Q: Who can use DSHS Form 10-673?A: Anyone applying for ICF/IID or NF services at an RHC in Washington can use DSHS Form 10-673.

Q: Are there any fees associated with submitting DSHS Form 10-673?A: There are no fees associated with submitting DSHS Form 10-673.

Q: What supporting documents are required with DSHS Form 10-673?A: The required supporting documents may vary, but generally include proof of residency, income, and disability.

Q: What is the purpose of DSHS Form 10-673?A: The purpose of DSHS Form 10-673 is to request ICF/IID or NF services at an RHC admission application in Washington.

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Form Details:

  • Released on May 1, 2022;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • 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 DSHS Form 10-673 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 10-673 Request for Icf / Iid or Nf Services at an Rhc Admission Application - Washington

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