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
13-692A Assisted Living Facility (ALF) Dementia Screening Tool
17-333 Assisted Living Facility / Enhanced Services Facility / Adult Family Home Request for Records (Residential Care Services)
10-372 Assisted Living Facility Contract Requirements - Attachment N
10-367 Assisted Living Facility Environmental Observations - Attachment I
10-371 Assisted Living Facility Exit Preparation Worksheet - Attachment M
10-577 Assisted Living Facility Follow Up Visit
10-486 Assisted Living Facility Food Service Observations - Attachment P (Residential Care Facilities, Aging and Long-Term Support Administration)
10-601 Assisted Living Facility Information Changes
10-591 Assisted Living Facility License Application
10-696 Assisted Living Facility Medication Observation Worksheet (Home and Community Living Administration)