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(asc) | Form Name | File Format | |
|---|---|---|---|
| 16-348 | Adult Family Home Psychology Associate Consultation Referral (Developmental Disabilities Administration) | ||
| 16-347 | Health-Related Social Needs (HRSN) Nutritional Supports | ||
| 16-346 | Assisted Living Facilities (ALF) Certified Memory Care Disclosure (Residential Care Services) | ||
| 16-345 | Health Related Social Needs (HRSN) Home Accessibility | ||
| 16-343 | Student Status Confirmation | ||
| 16-303 | Recommended Diversion Plan (Office of Forensic Mental Health) | ||
| 16-302 | Residency Agreement Language (Home and Community Living Administration) | ||
| 16-289 | DSHS New School District Notification following Mutual Acceptance into RHDY (Residential Habilitation for Dependent Youth) | ||
| 16-288 | Pre-Occupancy Worksheet: Resident Room / Bathroom (Residential Care Services) | ||
| 16-287 | Pre-Occupancy Inspection Checklist (Surveyor Use) (Residential Care Services) | ||
| 16-286 | RCS Nursing Home Pre-Occupancy Inspection Follow-Up Site Visit (Residential Care Services) | ||
| 16-285 | RCS Nursing Home Pre-Occupancy Inspection Site Visit – Initial Findings (Residential Care Services) | ||
| 16-284 | Pre-Occupancy Inspection Checklist (NH Administrator Use) (Residential Care Services) | ||
| 16-282 | Independent Informal Dispute Resolution (IIDR) Request (Residential Care Services) | ||
| 16-280 | Individual Home and Community Based Settings (HCBS) Checklist for Residential Providers Resources | ||
| 16-279 | Your Responsibility for Participation Towards Costs of Care at a Youth Transitional Care Facility (Developmental Disabilities Administration) | ||
| 16-278 | Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation) | ||
| 16-277 | Adult Family Home (AFH) Confirmation Letter (Residential Care Services) | ||
| 16-276 | Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS)) | ||
| 16-275 | Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services) | ||
| 16-273 | Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration) | ||
| 16-270 | Adult Family Home Agrees to Postpone Inspection Date Letter (Residential Care Services) | ||
| 16-269 | Adult Family Home No One Home Letter (Residential Care Services) | ||
| 16-268 | Adult Family Home Post-Licensing Instructions (Residential Care Services) | ||
| 16-267 | Integrated Settings Review for Resource Managers (Developmental Disabilities Administration) |
