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 | |
|---|---|---|---|
| 02-589 | Companion Home Outside Employment Notification and Review (Developmental Disabilities Administration) | ||
| 02-586 | Temporary Employment Hours Tracking Log | ||
| 02-569O | Appendix N: Conflict of Interest Reporting for DSHS Employees Only (Research and Data Analysis) | ||
| 02-569N | Appendix N: Conflict of Interest Reporting (Research and Data Analysis) | ||
| 02-569H | Appendix H: Resource Requests (Research and Data Analysis) | ||
| 02-569G | Appendix G: State Agency Records Request (Research and Data Analysis) | ||
| 02-566 | Protected Health Information (PHI) Amendment | ||
| 02-531 | Native Language Identifier | ||
| 02-528 | Fair Hearing Withdrawal |
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| 02-516 | Adult Family Home Resident Personal Belongings Inventory (Residential Care Services) | ||
| 01-212 | Nurse Delegation Referral and Communication | ||
| 01-210 | Transmittal of Client Funds from the Protective Payee | ||
| 01-205 | Able Bodied Adults Without Dependents (ABAWD) Activity Report |
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| 01-110C | Protective Payee Report Continuation | ||
| 01-110A | Protective Payee Periodic Social Services Report | ||
| 01-110 | Protective Payee Report |
