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
10-558A Condensed Resident / Representative Interview (Residential Care Services)
10-489 Confidential Health Information Consent Agreement
14-012 Consent
27-222 Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application
14-547 Continuing Care Retirement Community (CCRC) Registration Application
15-556 Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration)
15-547 Continuing Education Event Approval Application (Aging and Long-Term Support Administration)
14-544 Continuing Education Summary for DVPT Providers (Domestic Violence Intervention Treatment)
10-415 Contract Monitoring Checklist On-Site Review (Office of Refugee and Immigrant Assistance)
11-084 Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation)