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(asc) | File Format | |
|---|---|---|---|
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 10-488 | Extended Foster Care Program Consent | ||
| 10-562 | Exit Preparation Worksheet (Residential Care Services) | ||
| 10-663 | Existing Companion Home (CH) Movers Checklist (Developmental Disabilities Administration) | ||
| 16-278 | Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation) | ||
| 27-257 | Exhibit 359 Follow-Up Investigation Report (Residential Care Services) | ||
| 27-258 | Exhibit 358: Initial Report (Residential Care Services) | ||
| 07-107 | Exception to Rule and Notice Guardianship Fees and Related Costs (Aging and Long-Term Support Administration and Developmental Disabilities Administration) | ||
| 14-454 | Estate Recovery: Repaying the State for Medical and Long Term Services and Supports |
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| 03-374D | ESA Non-Dislcosure of Confidential Information Agreement - Non Employee | ||
| 10-662 | Equine Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 14-462 | Epilepsy Verification Request (Developmental Disabilities Administration) | ||
| 10-554 | Environmental Tour - Bedrooms (Residential Care Services) | ||
| 10-553 | Environmental Tour (Residential Care Services) | ||
| 27-260 | Environmental Adaptation Property Release Agreement | ||
| 10-550 | Entrance Information and Observation (Residential Care Services) | ||
| 15-603 | Enhanced Services Facility Medication Observation Worksheet (Residential Care Services) | ||
| 10-602 | Enhanced Services Facility Information Changes | ||
| 10-535 | Enhanced Services Facility Application | ||
| 15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
| 15-585B | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 12-hour Shift (Residential Care Services) | ||
| 15-585 | Enhanced Services Facility (ESF) Staff Schedule Worksheet (Residential Care Services) | ||
| 10-703 | Enhanced Services Facility (ESF) Staff Interview (Residential Care Services) | ||
| 15-579 | Enhanced Services Facility (ESF) Staff and Administrative Record Review | ||
| 15-578 | Enhanced Services Facility (ESF) Resident Record Review |
