WA DSHS 13-780 2017-2025 free printable template

DATE OF SERVICE AGING AND LONGER SUPPORT ADMINISTRATION (ALTA)Nursing Services Basic Skin Assessment (Integumentary System Skin, Hair, Nail) CLIENT NAMED ATE OF BIRTH CM / RN NAME REFERRING RN NAMECLIENT

How to fill out nursing basic skin assessment

How to fill out WA DSHS 13-780

1. Obtain the WA DSHS 13-780 form from the Washington State Department of Social and Health Services website or your local office.
2. Read the instructions carefully to understand the requirements for filling out the form.
3. Provide your personal information in the designated fields, including your name, address, and contact information.
4. Fill out the sections regarding your financial information, ensuring all numbers are accurate and reflective of your current situation.
5. Complete any additional sections that are relevant to your application, such as household information or specific program details.
6. Review the entire form for accuracy and completeness before submitting.
7. Submit the completed form to the appropriate DSHS office, either in person or via mail.

Who needs WA DSHS 13-780?

1. Individuals applying for benefits or services through the Washington State Department of Social and Health Services.
2. People needing to report changes in their financial situation or household composition.
3. Clients of the DSHS who are required to submit a self-reporting form for eligibility purposes.

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What is WA DSHS 13-780?

WA DSHS 13-780 is a form used by the Washington State Department of Social and Health Services to collect information related to individuals receiving services or benefits.

Who is required to file WA DSHS 13-780?

Individuals receiving certain social and health services or benefits from the Washington State DSHS are required to file WA DSHS 13-780.

How to fill out WA DSHS 13-780?

To fill out WA DSHS 13-780, individuals need to provide accurate personal information, details about their service or benefit needs, and any relevant financial information as requested on the form.

What is the purpose of WA DSHS 13-780?

The purpose of WA DSHS 13-780 is to assess eligibility for services or benefits provided by the DSHS, ensuring that individuals receive the appropriate assistance.

What information must be reported on WA DSHS 13-780?

Information that must be reported on WA DSHS 13-780 includes personal identification details, address, income sources, household composition, and any other relevant information pertaining to the individual's need for services.