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
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
10-634 Medication Assistant Endorsement (Aging and Long-Term Support Administration)
13-953 Medication Administration Record (MAR) (Developmental Disabilities Administration)
15-398 Medically Intensive Children's Program (MICP) Application
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
06-173 Medical Evidence Reimbursement
14-144A Medical Disability Decision
14-431 Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration)
15-492 Medicaid Transformation Project Service Notice
05-255 Medicaid Transformation Project Notice of Action Exception to Rule