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
02-751 Accommodations / Modifications Request
14-225 Acknowledgement of Services
27-207 Acknowledgement Statement (Meaningful Day) (Home and Community Services)
05-262 Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment)
05-261 Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment)
10-389A Additional Room List For Assisted Living Facilities (ALF)
18-176A Address Release Information Letter
18-176 Address Release Information Letter
10-559 Administrative Records Review (Residential Care Services)
10-559B Administrative Records Review - Former Staff and Others with Unsupervised Access (Residential Care Services)