Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

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 Form File
10-564 Adult Family Home Floor Plan Key (Residential Care Services)
10-570 Intake and Referral (Home and Community Services)
10-571 Overnight Planned Respite Services Individualized Agreement
10-573 Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination
10-574A Transitional Care Planning and Tracking: Part A. Transition Preparation (Developmental Disabilities Administration)
10-574B Transitional Care Planning and Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration)
10-574C Transitional Care Planning Tracking: Part C. Post Move and Stabilization (Developmental Disabilities Administration)
10-575 Adult Family Home (AFH) Inspection Packet (Residential Care Services)
10-576 Assisted Living Facility Pre-Inspection Preparation (Residential Care Services)
10-577 Assisted Living Facility Follow Up Visit