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
18-097 Statement of Resources and Expenses
18-078 Application for Nonassistance Support Enforcement Services
17-345 Transitional Care Management Exchange of Information (Developmental Disability Administration)
17-337 Personal Service Request / Standard Referral (Behavioral Health Administration)
17-337 Personal Service Request / Standard Referral (Developmental Disabilities Administration)
17-333 Assisted Living Facility / Enhanced Services Facility / Adult Family Home Request for Records (Residential Care Services)
17-305 DPI Authorization for Release of Information (Division of Program Integrity)
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
17-300 BHA Personal Information Release (Behavioral Health Administration)
17-299 Vendor Agreement Information (Behavioral Health Administration)