Authorized Representative - Washington State Department of Social and . . . An Authorized Representative is someone you select to represent you when you apply for or receive benefits with the Department of Social and Health Services (DSHS) or Health Care Authority (HCA) The individual or organization you name is authorized to act on your behalf for eligibility purposes
Authorized representatives - Washington State Health Care Authority If a person is unable to designate an AREP due to a medical condition, an individual may designate himself or herself as the AREP by signing the agency's Authorized Representative Designation Form (DSHS 14-532)
Authorized Representatives (AREP) - Washington State Health Care Authority Clients use DSHS form 14-012 * to authorize an exchange of information outside of basic eligibility This form is Health Insurance Portability and Accountability (HIPAA) compliant This form is not used by HCA staff to identify an AREP
Authorized Representative - Washington Having an authorized representative is optional; DSHS or HCA cannot withhold benefits if you do not sign this form Which program(s) do you want your authorized representative to act on in your behalf? Check all that apply
Electronic DSHS Forms | DSHS - Washington State Department of Social . . . These are provided only if a DSHS program requests forms to be available electronically for public use DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files This means you can open, view, and print each form
DSHS Form 14-532 Authorized Representative - Washington - TemplateRoller Download Printable Dshs Form 14-532 In Pdf - The Latest Version Applicable For 2025 Fill Out The Authorized Representative - Washington Online And Print It Out For Free Dshs Form 14-532 Is Often Used In Washington State Department Of Social And Health Services, Washington Legal Forms And United States Legal Forms
Food, Cash and Medical Benefit Issuances - Washington The client can identify an AREP on the application, eligibility review form, or DSHS 14-532 authorized representative form The DSHS 14-532 authorized representative form shall be used when a client is authorizing an AREP at a time other than at application or eligibility review
Home | Washington State Health Care Authority Find resources to help you manage your enrollment, provide treatment, request prior authorization (PA), and file claims, including forms, billing guides, fee schedules, medical policies, and training materials for ProviderOne Find partner resources HCA is the largest purchaser of health care in the state