As a professional in the service industry, you know that it is important to keep up with changes in regulations. Recently, the Department of Social and Health Services (DSHS) updated Form Dshs 27-059. This form is used to request authorization for services for clients who are not Medicaid eligible or do not have other insurance coverage. The updates include clarifications about allowable services, as well as changes related to the new managed care programs. Make sure you are familiar with these changes so that you can provide appropriate services to your clients. You can find more information on the DSHS website at https://www5.dshs.wa.gov/forms/forms/27-059/.
|Form Name||Form Dshs 27 059|
|Form Length||1 pages|
|Avg. time to fill out||15 sec|
|Other names||Learners, 2012, OCA, Weekday|
Use this form to assist in scheduling a
Department of Social and Health Services fingerprint appointment.
Section 1: To be completed by the requesting agency
1.The agency requesting a fingerprint check must provide the following numbers:
BCCU Account Number:BCCU Inquiry ID/OCA Number:
Section 2: Information to gather BEFORE scheduling a fingerprint appointment
Be prepared to provide the information from Section 1 AND the information below when scheduling your fingerprint appointment.
1. Name (Last, First, Middle)
2. Address (Street, City, State, Zip Code)
3. Daytime Phone (Area Code and Number)
4. Social Security Number (Optional)
Caucasian or other Hispanic culture
Asian or Pacific Islander
American Indian, First Nations, Eskimo, or Alaskan Native
Section 3: Fill out this section WHILE scheduling your fingerprint appointment
1.Go to www.MorphoTrust.com or call
2.Use this space to write down the date, time and location of your fingerprint appointment:
Date / Weekday:
Location / Address:
Section 4: Personal Identification
You must bring one of the following
Government Issued PICTURE ID:
•US Driver’s License, or any Federal, State, or Local Government issued ID (Including a Washington State Learner’s Permit)
•Any US Armed Services ID (Army, Air Force, Navy, Marines, etc…)
•Foreign Passport (with photo and signature)
•Federally Recognized Tribal ID
All ID must be current. Expired identification WILL NOT be accepted unless you can prove that you are in the process of renewing it.
FINGERPRINT APPOINTMENT DSHS