Washington's DCYF Licensing Division uses this confidential report when a foster care or kinship caregiver applicant has a mental health provider. The provider describes past and current diagnoses, current functioning, medications and any concerns about caring for children. It is one part of the licensing review, and DCYF states that no single condition, disability or medication automatically disqualifies an applicant.
The applicant completes Section 1, naming the mental health provider and signing a release, and licensing or child placing agency staff add the licensor's details in Section 2. The mental health provider completes and signs Section 3.
Download the current version from the source each time; forms change without notice.
Applicant Mental Health Report - Confidential
This form is a Word template, not a PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The applicant's mental health provider completes Section 3, covering visit history, past and current diagnoses, current functioning, medications and how any condition may affect the care of children, then signs it. The applicant completes Section 1 and the release, and DCYF or child placing agency staff complete Section 2.
DCYF 13-001 is the Applicant Medical Report completed by the applicant's medical provider, centered on physical health, the most recent physical exam, diagnoses and prognosis. DCYF 13-001B is the Applicant Mental Health Report completed by a mental health provider, focused on diagnoses, current functioning and medication effects on supervising children.
The authorization the applicant signs in Section 1 is valid for one year from the date of signature. It lets the named mental health provider share the history items the applicant checks: mental health, sexual and physical abuse, substance use and domestic violence.