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.

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Number Form Name(asc) File Format
11-110 Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation)
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
17-321 Pre-Admission Screening and Resident Review (PASRR) Equipment Purchase Request
14-538 Pre-Admission Screening and Resident Review (PASRR) Addendum
15-382 Positive Behavior Support Plan (PBSP)
10-708 Planning for Youth Aged 18-21 Receiving RHDY Services (Developmental Disabilities Administration)
10-648 Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration)
10-573 Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination
13-021 Physical Evaluation
16-235 Photo Release
09-280B Petition for Modification - Administrative Order
10-629 Pet Record Review (Aging and Long-Term Support Administration)
17-337 Personal Service Request / Standard Referral (Developmental Disabilities Administration)
17-337 Personal Service Request / Standard Referral (Behavioral Health Administration)
11-154 Personal Pathway
17-180 Personal Information Release (Economic Services Administration)
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
15-291 Person Centered Service Planning and Annual Assessment Meeting
15-295 Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration)
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
10-509 Pediatric Symptoms Checklist (PSC-17)
27-053 Paternity Information
10-643 PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration)
10-668 PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration)
15-493 PASRR Client Referral