Public Disclosure Request

DBHR complies with the public disclosure requirements of RCW 42.56.  In DSHS, each division has a Public Disclosure Coordinator.  Requests for disclosure of public information of DBHR records should be sent to:

DBHR Public Disclosure Coordinator
P.O. Box 45330 (Mail Stop 45330)
Olympia, WA 98504-5330
Phone 360-725-3599 or Toll Free 1-877-301-4557
Fax 360-725-2279

Public Disclosure Forms

  • Request for Records, DSHS 17-041 ( Word )  ( PDF ) (To request DBHR records, including records about a DBHR contracted or certified agency.)
  • Authorization DSHS 17-063  ( Word  ) ( PDF  ) (Purpose: Use this form to request the release of your confidential patient/client information held by DSHS to another party.) PDF Translations: Arabic, Cambodian, Chinese, Croatian, Farsi, Hmong, Japanese, Korean, Laotian,  Russian,  Somali, Spanish, Tigrinya, Vietnamese