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
15-590 Adult Family Home (AFH) Quality Assurance Visit (Residential Care Services)
10-393B Cost Estimate Worksheet for Bone Anchored "Hearing Aid" Auditory Devices (BAHA) (Division of Vocational Rehabilitation)
10-393A Cost Estimate Worksheet for Cochlear Implants (Division of Vocational Rehabilitation)
27-258 Exhibit 358: Initial Report (Residential Care Services)
27-257 Exhibit 359 Follow-Up Investigation Report (Residential Care Services)
15-484 Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF/IID) Survey and Revisit Skill Building Tool
13-956 Skin Observation (Developmental Disabilities Administration)
13-955 Vital Signs Tracking (Developmental Disabilities Administration)
13-954 Seizure Protocol (Developmental Disabilities Administration)
13-953 Medication Administration Record (MAR) (Developmental Disabilities Administration)