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
02-740 Private Duty Nursing (PDN) Time Log for the Month of (Home and Community Services)
15-594 Private Duty Nursing (PDN) Care Plan (Aging and Long-Term Services Administration)
27-115 Privacy Complaint
17-208A PRISM Access Request for Multiple Organizations
13-783 Pressure Injury Assessment and Documentation (Home and Community Services)
17-284 Preferred Sign Language Interpreter List (Office of Deaf and Hard of Hearing)
10-268 Pre-Placement Agreement (Developmental Disabilities Administration)
16-288 Pre-Occupancy Worksheet: Resident Room / Bathroom (Residential Care Services)
16-287 Pre-Occupancy Inspection Checklist (Surveyor Use) (Residential Care Services)
16-284 Pre-Occupancy Inspection Checklist (NH Administrator Use) (Residential Care Services)