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
16-273 Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration)
01-212 Nurse Delegation Referral and Communication
13-960 Nurse Case Review Referral (Home and Community Services)
16-193 Nurse Aide Registry Inquiry (Home and Community Living Administration)
14-491 NSA Representative Checklist forDDA Review
10-301 Notification of Enrollment Review (Developmental Disabilities Administration)
15-290 Notification of Annual Assessment Review and Person Centered Services Planning Meeting
10-377 Notification of Age Four (4) Enrollment Expiration-
14-401A Notification of Address Disclosure Request - Part 2
14-401 Notification of Address Disclosure Request - Part 1