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(desc) | Form Name | File Format | |
|---|---|---|---|
| 27-253 | New Freedom Authorized Representative (Home and Community Services) | ||
| 27-257 | Exhibit 359 Follow-Up Investigation Report (Residential Care Services) | ||
| 27-258 | Exhibit 358: Initial Report (Residential Care Services) | ||
| 27-260 | Environmental Adaptation Property Release Agreement | ||
| 27-261 | Integrated Settings Provider Attestation (Developmental Disabilities Community Services) | ||
| 27-269 | Authorization to Release Information (Office of Refugee and Immigrant Assistance) |
|
|
| 27-272 | Area Agency on Aging (AAA) Health-Related Social Needs (HRSN) Direct Service Approval | ||
| 27-273 | WA Cares Fund Provider Request for Exception to Rule | ||
| 27-274 | Enhanced Living Facility (ESF) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-275 | Adult Family Home (AFH) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-276 | Assisted Living Facility (ALF) Exhibit 359 Five Working Days Incident Follow-up Report | ||
| 27-277 | Property Owner Statement (Home and Community Living Administration) |
