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 | |
|---|---|---|---|
| 15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
| 10-535 | Enhanced Services Facility Application | ||
| 10-602 | Enhanced Services Facility Information Changes | ||
| 15-603 | Enhanced Services Facility Medication Observation Worksheet (Residential Care Services) | ||
| 10-550 | Entrance Information and Observation (Residential Care Services) | ||
| 10-553 | Environmental Tour (Residential Care Services) | ||
| 10-554 | Environmental Tour - Bedrooms (Residential Care Services) | ||
| 14-462 | Epilepsy Verification Request (Developmental Disabilities Administration) | ||
| 10-662 | Equine Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 03-374D | ESA Non-Dislcosure of Confidential Information Agreement - Non Employee | ||
| 14-454 | Estate Recovery: Repaying the State for Medical and Long Term Services and Supports |
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| 07-107 | Exception to Rule and Notice Guardianship Fees and Related Costs (Aging and Long-Term Support Administration and Developmental Disabilities Administration) | ||
| 27-258 | Exhibit 358: Initial Report (Residential Care Services) | ||
| 27-257 | Exhibit 359 Follow-Up Investigation Report (Residential Care Services) | ||
| 16-274 | Exhibit B: School-to-Work County Mentorship Program Monthly Tracking and Reporting (Division of Vocational Rehabilitation) | ||
| 16-278 | Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation) | ||
| 10-663 | Existing Companion Home (CH) Movers Checklist (Developmental Disabilities Administration) | ||
| 10-562 | Exit Preparation Worksheet (Residential Care Services) | ||
| 10-488 | Extended Foster Care Program Consent | ||
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 15-555 | Facility Training Program Application and Updates (Home and Community Services) | ||
| 02-753 | Facility Virtual Classroom Training Application and Attestation (Home and Community Services) | ||
| 02-528 | Fair Hearing Withdrawal |
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| 20-273 | Family Agreement to Children's Intensive In-home Behavioral Support (CIIBS) Program | ||
| 13-713 | Fast Track Service Agreement |
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