The DSHS Consent form is used as a release of information. Participants must complete, sign and submit the DSHS Consent Form 14-012 before providers can access participant’s information in eJAS. The Consent form includes the participant identification number, contracted provider name and length consent is valid for date. The Consent form cannot be pre-filled. We will accept an electronically signed consent (such as a PDF) or a photo of a signed consent form.
Consent forms cannot be pre-filled by the provider with the exception of the section directly following “Please check all below who are included in this consent in addition to DSHS and identify them by name and address:” We recommend preselecting “Other DSHS Contracted providers” and including your agency name. If another agency is part of your agency’s BFET services, such as a subcontractor, you will also want to include them on this line.