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
10-487 Assisted Living Facility Medication Pass Worksheet - Attachment Q
10-689 Assisted Living Facility Monitoring Visit (Residential Care Services)
10-370 Assisted Living Facility Notes / Worksheet - Attachment L
10-366 Assisted Living Facility Other Contact Interview - Attachment H
16-197 Assisted Living Facility Policies and Procedures Attestation
10-359 Assisted Living Facility Pre Inspection Preparation - Attachment A
10-576 Assisted Living Facility Pre-Inspection Preparation (Residential Care Services)
10-360 Assisted Living Facility Request for Documentation - Attachment B
10-362 Assisted Living Facility Resident Characteristic Roster and Sample Selection - Attachment D
10-362A Assisted Living Facility Resident Characteristic Roster and Sample Selection Addendum - Attachment D