DSHS Form 10-489 Confidential Health Information Consent Agreement or Withdrawal - Washington

What Is DSHS Form 10-489?

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 10-489?
A: DSHS Form 10-489 is the Confidential Health Information Consent Agreement or Withdrawal form used in the state of Washington.

Q: What is the purpose of DSHS Form 10-489?
A: The purpose of DSHS Form 10-489 is to provide consent for the release of confidential health information or to withdraw a previous consent in Washington.

Q: Who uses DSHS Form 10-489?
A: DSHS Form 10-489 is used by individuals in Washington who want to give or withdraw their consent for the release of confidential health information.

Q: What information is required on DSHS Form 10-489?
A: DSHS Form 10-489 requires your personal information, such as name and contact details, as well as specific information regarding the healthcare provider and the purpose of the consent.

Q: Is DSHS Form 10-489 legally binding?
A: Yes, DSHS Form 10-489 is a legally binding document in the state of Washington.

Q: Can I withdraw my consent after submitting DSHS Form 10-489?
A: Yes, you can withdraw your consent for the release of confidential health information by submitting a new DSHS Form 10-489 indicating the withdrawal.

Q: Who should I contact for more information about DSHS Form 10-489?
A: For more information about DSHS Form 10-489, you can contact the Washington State Department of Social and Health Services (DSHS) or consult with your healthcare provider.