Applications and Forms

• BHA License Application (PDF)
• Deeming Application (PDF)
• Mobile Unit Notification (PDF)
• Hospital BHA Additional Site Form (PDF)
• BHA Closure Form (PDF)
• Disclosure Statement (PDF) 

Tribal BHAs applying for licensure and certification may attest that its agency meets the state minimum standards. The department does not assert regulatory jurisdiction over a BHA license issued under a tribal attestation. Once the department accepts the tribal attestation, a BHA license will be issued to the undersigned tribe and include the tribe on the current list of licensed behavioral health agencies (PDF).

• Washington State Department of Health Tribal Attestation for Behavioral Health Agencies: For Substance Use Disorder Services, Mental Health Services, and Licensure (PDF)
• Tribal Application for Behavioral Health Agency License (PDF)
• Tribal Attestation administrative processing fee
• Tribal BHA Attestation FAQ (PDF)

Mail completed tribal attestation form, tribal application for BHA license, and administrative processing fee of $261 to:

Department of Health
P.O. Box 1099
Olympia, WA 98507-1099

See the Tribal Attestation FAQ (PDF) or call 360-236-4700 with questions about tribal attestation or renewals.

• BHA License Application (PDF)
• Community Relations Plan (PDF)
• Mobile Unit Notification (PDF)

• All BHA applications for initial licensure and certification or adding certifications and services must include the submission of policies and procedures for review and approval. An agency's policies and procedures must address the requirements in chapter 246-341 WAC, and describe how the WAC requirements are implemented at your agency.
• WAC 246-341 Policy and Procedure Review Tool (PDF) – this tool is designed as a guide for developing policies and procedures.