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 Sort descending Form Name Form File
12-212 Waiver of Administrative Disqualification Hearing (Community Services Division)
13-021 Physical Evaluation
13-585A Range of Joint Motion Evaluation Chart
13-645 Adult Family Home Injuries and Accidents Log
13-678 Page 1 Nurse Delegation: Consent for Delegation Process
13-678 Page 2 Nurse Delegation: Instructions for Nursing Task
13-678A Nurse Delegation: PRN Medication
13-678B Nurse Delegation: Assumption of Delegation
13-680 Nurse Delegation: Rescinding Delegation
13-681 Nurse Delegation: Change in Medical Orders