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
27-123 Provider Owned Housing Memorandum of Understanding Renter Attestation
10-560 Provider / Resident Manager Interview (Residential Care Services)
01-110C Protective Payee Report Continuation
01-110 Protective Payee Report
01-110A Protective Payee Periodic Social Services Report
14-426 Protective Payee Payment Plan, Case Assignment, and Closure Notice
14-453 Protective Payee Decision
14-349 Protective Payee Assessment
02-566 Protected Health Information (PHI) Amendment
15-344 Private Duty Nursing Logs and Skilled Nursing Tasks Log