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
16-343 Student Status Confirmation
16-345 Health Related Social Needs (HRSN) Home Accessibility
16-346 Assisted Living Facilities (ALF) Certified Memory Care Disclosure (Residential Care Services)
16-347 Nutritional Support (Health Related Social Needs Program)
16-348 Adult Family Home Psychology Associate Consultation Referral (Developmental Disabilities Administration)
16-349 Stabilization, Assessment, and Intervention Facility (SAIF) Providers Certification Evaluation Checklist (Developmental Disabilities Administration)
16-350 Integrated Settings Review: Individual Interviews (Developmental Disabilities Administration)
16-351 Integrated Settings Initial Screening Tool All Settings (Developmental Disabilities Administration)
16-352 Crisis Prevention, Intervention, and Stabilization (CPIS) Services Initial Plan and Progress Report (Developmental Disabilities Administration)
16-355 Home Accessibility and Remediation Homeowner Consent Agreement (Home and Community Living Administration)