WA DOH 670-064 2019 free printable template
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Substance Use Disorder Credentialing
P.O. Box 47877
Olympia, WA 985047877
3602364700Verification of Substance Use Disorder Professionalize: Use one form per supervisor for each time frame worked.
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How to fill out WA DOH 670-064
01
Obtain the WA DOH 670-064 form from the Washington Department of Health website or your local health department.
02
Fill in the applicant's name and contact information at the top of the form.
03
Provide any relevant identification numbers, such as a Social Security Number or license number, if required.
04
Complete the section describing the purpose of the request or the information needed.
05
If applicable, indicate the specific records or information you are requesting.
06
Sign and date the form at the bottom to certify that the information provided is accurate.
07
Submit the completed form to the appropriate department or agency as indicated in the instructions.
Who needs WA DOH 670-064?
01
Individuals seeking access to their health information or medical records.
02
Parents or guardians requesting health information for their children.
03
Health care providers needing to access patient records for treatment purposes.
04
Legal representatives requiring health information for legal proceedings.
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What is WA DOH 670-064?
WA DOH 670-064 is a form used by the Washington State Department of Health for reporting specific health-related information.
Who is required to file WA DOH 670-064?
Individuals or organizations involved in specified reporting activities in the healthcare sector are required to file WA DOH 670-064.
How to fill out WA DOH 670-064?
To fill out WA DOH 670-064, follow the instructions provided on the form, ensuring all required fields are completed accurately and submitting it as per the guidelines outlined by the Washington State Department of Health.
What is the purpose of WA DOH 670-064?
The purpose of WA DOH 670-064 is to collect essential health data for monitoring and improving public health initiatives in the state of Washington.
What information must be reported on WA DOH 670-064?
WA DOH 670-064 requires reporting various health-related information, including patient demographics, health conditions, and treatment details.
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