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
27-272 Area Agency on Aging (AAA) Health-Related Social Needs (HRSN) Direct Service Approval
27-269 Authorization to Release Information (Office of Refugee and Immigrant Assistance)
27-261 Integrated Settings Provider Attestation (Developmental Disabilities Community Services)
27-260 Environmental Adaptation Property Release Agreement
27-258 Exhibit 358: Initial Report (Residential Care Services)
27-257 Exhibit 359 Follow-Up Investigation Report (Residential Care Services)
27-253 New Freedom Authorized Representative (Home and Community Services)
27-252 Adult Family Home Applicant Attestation Concerning Household Members and Background Check Requirements (Residential Care Services)
27-248 Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration)
27-247 Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration)