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 | |
|---|---|---|---|
| 27-223 | Adult Family Home Policies and Procedures Attestation | ||
| 27-222 | Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application | ||
| 27-220 | Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration) | ||
| 27-219 | Death Notification Checklist for Medical Providers (Developmental Disabilities Administration) | ||
| 27-218 | Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration) | ||
| 27-215 | Teleservice Agreement (Developmental Disabilities Administration) | ||
| 27-210 | DDA Authorization for Release of Referral Video (Developmental Disabilities Administration) | ||
| 27-209 | Nursing Home Informal Dispute Resolution Request (Residential Care Services) | ||
| 27-208 | Declaration to Adult Protective Services | ||
| 27-207 | Acknowledgement Statement (Meaningful Day) (Home and Community Services) | ||
| 27-189 | Asset Verification Authorization (Home and Community Services) | ||
| 27-188 | Initial Opiate Prescription Informed Consent (Behavioral Health Administration) | ||
| 27-182 | DSHS Request for Positive Identification – Thumbprint | ||
| 27-179 | Adult Family Home (AFH) Informal Dispute Resolution (IDR) Request (Residential Care Services) | ||
| 27-178 | Adult Protective Services (APS) Administrative Hearing Request | ||
| 27-176 | Release of Liability (Developmental Disabilities Administration) | ||
| 27-175 | DVR Additional Contractor Information (Division of Vocational Rehabilitation) | ||
| 27-156 | Notice and Consent of Communication via Text or Unencrypted Email |
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| 27-155 | Declaration on Commercial Purposes | ||
| 27-147A | In-Home Environmental Adaptations General Utility and Repair Property Release Agreement (Aging and Long-Term Support Administration) | ||
| 27-147 | Housing Modification Property Release Agreement | ||
| 27-143 | CSD ABD Medical Evidence Review Contractor Self-Assessment Monitoring Tool | ||
| 27-130 | Authorization for Alternate EBT Cardholder |
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| 27-124 | Provider Owned Housing Memorandum of Understanding Residential Provider Attestation | ||
| 27-123 | Provider Owned Housing Memorandum of Understanding Renter Attestation |
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