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
15-291 Person Centered Service Planning and Annual Assessment Meeting Notice (Developmental Disabilities Community Services)
15-295 Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration)
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
10-509 Pediatric Symptoms Checklist (PSC-17)
27-053 Paternity Information
10-643 PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration)
10-668 PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration)
07-081 Participation Reimbursement
04-449 Participants Feedback (Domestic Violence Intervention Treatment)
07-103A Participant Reimbursement with Interpreter Declaration