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
10-552 Staff List (Residential Care Services)
10-551 Resident List (Residential Care Services)
10-550 Entrance Information and Observation (Residential Care Services)
10-549 Inspection Process and Records Request (Residential Care Services)
10-548 Pre-Inspection Preparation (Residential Care Services)
10-326A Staffed Residential Home DCYF Billing
15-602 Enhanced Services Facility (ESF) Monitoring Visit (Residential Care Services)
17-305 DPI Authorization for Release of Information (Division of Program Integrity)
06-196 DPI Tribal Income Verification (Division of Program Integrity)
06-195 DPI Statement of Income (Division of Program Integrity)