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 | |
|---|---|---|---|
| 10-643 | PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
| 10-642 | Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services) | ||
| 10-641 | Community Instructor Qualification Tool (Home and Community Services) | ||
| 10-640 | Hands-On Skills Training: Planning Attestation (Home and Community Services) | ||
| 10-639 | Overnight Planned Respite Services (OPRS) Certification Evaluation (Home and Community Living Administration) | ||
| 10-638 | AFH Meaningful Day - Monthly Activities and Challenging Behavior Log | ||
| 10-637 | Meaningful Activity Plan (MAP) Discovery | ||
| 10-636 | Meaningful Day Monthly Calendar | ||
| 10-635 | Residential Transition Exchange of Information (Developmental Disabilities Administration) | ||
| 10-634 | Medication Assistant Endorsement (Aging and Long-Term Support Administration) | ||
| 10-633 | TB Testing Review for Resident (Aging and Long-Term Support Administration) | ||
| 10-632 | TB Testing Review for Staff (Aging and Long-Term Support Administration) | ||
| 10-631 | Staff Qualification and Background Review (Home and Community Living Administration) | ||
| 10-630 | Paid Feeding Assistant Program Review (Aging and Long-Term Support Administration) | ||
| 10-629 | Pet Record Review (Aging and Long-Term Support Administration) | ||
| 10-628 | Trust Fund Review (Aging and Long-Term Support Administration) | ||
| 10-627 | Liability Insurance Review (Aging and Long-Term Support Administration) | ||
| 10-626 | Staffing Pattern (Aging and Long-Term Support Administration) | ||
| 10-625 | State Task Checklist (Aging and Long-Term Support Administration) | ||
| 10-623 | DDA PASRR Significant Change Invalidation (Developmental Disabilities Administration) (Pre-Admission Screening and Resident Review) | ||
| 10-622 | Certified Community Residential Services(CCRSS) Group Training Home Food Service Review (Residential Care Services) and Supports | ||
| 10-621 | Certified Community Residential Services and Supports (CCRSS) Notes (Residential Care Services) | ||
| 10-620 | Certified Community Residential Services and Supports (CCRSS) Residential Cost Report – ISS Hours Review / Questionnaire (Residential Care Services) | ||
| 10-619 | Certified Community Residential Services and Supports (CCRSS) Staff Background Check and Record Review (Residential Care Services) | ||
| 10-617B | Certified Community Residential Services and Supports (CCRSS) Group Training Home (GTH) Client Environment and Safety Worksheet (Residential Care Services) |
