WA DOH 670-114 2014 free printable template
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Agency Affiliated Counselor Credentialing P. O. Box 47877 Olympia WA 98504-7877 360-236-4700 Check One c New Agency c Update / Change Agency c Additional Agency Applicants may not provide unsupervised counseling prior to completion of a criminal background check performed by either the employer or the Department of Health. Agency or Facility Employer Name City State Zip Code My Agency is a county state agency federally recognized Indian tribe located within Washington State or has been...
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How to fill out WA DOH 670-114
01
Obtain a copy of the WA DOH 670-114 form from the Washington State Department of Health website or your local health department.
02
Start by filling out the top section with your personal information, including your name, address, and contact details.
03
Next, specify the type of health-related service you are requesting or reporting on the form.
04
In the designated section, provide any additional required details, such as dates, locations, and descriptions related to the request.
05
If applicable, include any supporting documentation by attaching it to the form.
06
Review the form for completeness and accuracy before submission.
07
Submit the completed form according to the instructions provided, either via mail, email, or in-person at your local health department.
Who needs WA DOH 670-114?
01
Individuals seeking to report a health issue or request a health-related service in Washington State.
02
Healthcare providers submitting information related to patient care or health services.
03
Organizations or entities needing to comply with health reporting requirements mandated by Washington State law.
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What is WA DOH 670-114?
WA DOH 670-114 is a report form used by the Washington State Department of Health for the purpose of collecting specific public health data.
Who is required to file WA DOH 670-114?
Healthcare providers, facilities, or organizations that are mandated to report certain health-related information to the Washington State Department of Health are required to file WA DOH 670-114.
How to fill out WA DOH 670-114?
To fill out WA DOH 670-114, obtain the form from the Department of Health's website, provide the required information accurately, ensure all fields are completed, and submit the form according to the provided instructions.
What is the purpose of WA DOH 670-114?
The purpose of WA DOH 670-114 is to gather data that assists in monitoring and improving public health programs and policies in the state of Washington.
What information must be reported on WA DOH 670-114?
The information that must be reported on WA DOH 670-114 includes demographic data, health condition specifics, treatment information, and any other relevant details as specified by the reporting guidelines.
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