Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.

We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.

Number Form Name Form File
20-336 WA Cares Fund Application for Long-Term Care Benefits
20-337 WA Cares Fund 90-Day Certification
20-339 WA Cares Authorized User
14-555 WA Cares Application Attestation
20-335 WA Care Fund Rights and Responsibilities
16-234 Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF)
16-234A Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC))
15-184 Volunteer Chore Service Referral
09-004C Voluntary Placement Agreement for Child or Youth with Developmental Disabilities
10-424 Voluntary Participation Statement (Developmental Disability Administration)