Electronic DSHS Forms
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(desc) | File Format | |
|---|---|---|---|
| 10-571 | Overnight Planned Respite Services Individualized Agreement | ||
| 10-630 | Paid Feeding Assistant Program Review (Aging and Long-Term Support Administration) | ||
| 07-103A | Participant Reimbursement with Interpreter Declaration | ||
| 04-449 | Participants Feedback (Domestic Violence Intervention Treatment) | ||
| 07-081 | Participation Reimbursement | ||
| 15-493 | PASRR Client Referral | ||
| 10-668 | PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration) | ||
| 10-643 | PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
| 27-053 | Paternity Information | ||
| 10-509 | Pediatric Symptoms Checklist (PSC-17) | ||
| 27-096 | Permission to Share Documents for Reimbursement of Health Care Expenses | ||
| 15-295 | Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration) | ||
| 15-291 | Person Centered Service Planning and Annual Assessment Meeting |
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| 16-205 | Personal Emergency Plan Information (Developmental Disabilities Administration (DDA)) | ||
| 17-180 | Personal Information Release (Economic Services Administration) | ||
| 11-154 | Personal Pathway | ||
| 17-337 | Personal Service Request / Standard Referral (Behavioral Health Administration) | ||
| 17-337 | Personal Service Request / Standard Referral (Developmental Disabilities Administration) | ||
| 10-629 | Pet Record Review (Aging and Long-Term Support Administration) | ||
| 09-280B | Petition for Modification - Administrative Order |
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| 16-235 | Photo Release | ||
| 13-021 | Physical Evaluation | ||
| 10-573 | Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination | ||
| 10-648 | Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
| 10-708 | Planning for Youth Aged 18-21 Receiving RHDY Services (Developmental Disabilities Administration) |
