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(asc) Form Name File Format
15-376 Skin Observation Protocols
15-365 Community Protection Treatment Worksheet Quarterly Review
15-360 Residential Services Vacancy Profile (Developmental Disabilities Administration)
15-358 Client Referral Summary (Developmental Disabilities Administration)
15-356 DDA Community Protection Program Chaperone Agreement
15-344 Private Duty Nursing Logs and Skilled Nursing Tasks Log
15-342 Notice of Decision (Non-PC) Exception to Rule (Developmental Disabilities Administration)
15-331 Annual Assessment Checklist (Developmental Disability Administration)
15-318 Crisis Diversion Bed Referral and Intake Information (Developmental Disabilities Administration)
15-314 Client Necessary Supplemental Accommodation Representative Requirement Checklist
15-304 HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration)
15-295 Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration)
15-291 Person Centered Service Planning and Annual Assessment Meeting Notice (Developmental Disabilities Community Services)
15-290 Notification of Annual Assessment Review and Person Centered Services Planning Meeting
15-274 Assistance Available Schedule (DDA)
15-215 DDCS AFH Quality Improvement Visit Assessment (Development Disabilities Community Living / Adult Family Home)
15-184 Volunteer Chore Service Referral
15-031 Nursing Facility Notice of Action
14-556 Health-Related Social Needs (HRSN) Provider Application
14-555 WA Cares Application Attestation
14-554 Household Application for Sun Bucks
14-553 High School Home Care Aide Training Program and Instructor Application and Updates (Aging and Long-Term Support Administration)
14-552 TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing)
14-551 Adult Family Homes (AFH) State Civil Penalty Reinvestment Program Grant Application
14-550 Job Foundation Application (Developmental Disabilities Administration)