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
07-103 Basic Food Employment and Training (BFET) Participant Reimbursement
27-109 BCCU Applicant Affidavit
13-712 Behavioral Health Wraparound Support (BHWS) Request (Home and Community Services Administration)
17-300 BHA Personal Information Release (Behavioral Health Administration)
13-952 Bowel Protocol (Developmental Disabilities Administration)
02-766 Care Agreement for Beneficiaries and their Caregivers (WA Cares)
05-272 Case Manager Instructions Following a Hearing Decision
02-760 Case Mix Index Detail (CMID) Report Authorization (Home and Community Living Administration (HCLA))
27-228 CCLS Additional Delegated Authority Request
27-234 CCLS Small Business Self-Certification Statement