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
03-077 Release of All Claims
06-200 Registered Nurse (RN) Delegation Billing
15-419 Refusal of Services Statement
10-501 Referral to DSHS for Basic Food Employment and Training (BFET)
16-303 Recommended Diversion Plan (Office of Forensic Mental Health)
16-285 RCS Nursing Home Pre-Occupancy Inspection Site Visit – Initial Findings (Residential Care Services)
16-286 RCS Nursing Home Pre-Occupancy Inspection Follow-Up Site Visit (Residential Care Services)
15-456 RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults
13-945 RCS Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Notes (Residential Care Services)
13-941 RCS (AFH, ALF, ESF) Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services)