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
21-061 Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration)
02-589 Companion Home Outside Employment Notification and Review (Developmental Disabilities Administration)
10-685 Companion Home Provider Supplemental Information (Developmental Disabilities Administration)
15-516 Companion Home Quarterly Report (Developmental Disabilities Administration)
17-262 Companion Home Site Review for Physical and Safety Requirements (Home and Community Living Administration)
10-642 Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services)
10-596 Comprehensive Functional Assessment of Adult Training Programs
10-349 Comprehensive Regional Review Tool
10-558 Comprehensive Resident / Representative Interview (Residential Care Services)
10-558A Condensed Resident / Representative Interview (Residential Care Services)