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
20-336 WA Cares Fund Application for Long-Term Care Benefits
20-337 WA Cares Fund 90-Day Certification
20-338 Limited Power of Attorney for WA Cares Fund Benefits
20-339 WA Cares Authorized User
20-340 Individualized Community Transition Planning Summary (Home and Community Services)
20-341 WA Cares Fund Provider Application for Registration
21-059 Children's Staffed Residential Quality Assurance Assessment
21-060 Children’s State Operated Living Alternative (SOLA) Quality Assurance Assessment
21-061 Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration)
21-065 Adult Family Home (AFH) Emergency Evacuation Drill