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 | |
|---|---|---|---|
| 15-599 | Early Engagement of Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services) | ||
| 15-597 | DDA Youth Transitional Care Facility Admission Checklist (Developmental Disabilities Administration) | ||
| 15-596 | Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Referral (Home and Community Services) | ||
| 15-595 | Children's Behavior Intervention Plan (Developmental Disabilities Administration) | ||
| 15-594 | Private Duty Nursing (PDN) Care Plan (Aging and Long-Term Services Administration) | ||
| 15-593 | 21-Day Competency Check Request (Behavioral Health Administration) | ||
| 15-591 | High School Home Care Aide Instructor Application (Home and Community Services) | ||
| 15-589C | Adult Family Home (AFH) Relocation Initial Licensing Inspection (Residential Care Services) | ||
| 15-589B | Adult Family Home (AFH) Licensing: Resident Bedroom / Bathroom Worksheet Continuation (Residential Care Services) | ||
| 15-589A | Adult Family Home (AFH) LIcensing Inspection Floor Plan "Key" (Residential Care Services) | ||
| 15-589 | Adult Family Home (AFH) Initial Licensing Inspection (Residential Care Services) | ||
| 15-586 | Enhanced Services Facility (ESF) Inspection Packet | ||
| 15-585B | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 12-hour Shift (Residential Care Services) | ||
| 15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
| 15-585 | Enhanced Services Facility (ESF) Staff Schedule Worksheet (Residential Care Services) | ||
| 15-584 | Enhanced Services Facility (ESF) Medication Pass Worksheet | ||
| 15-583 | Enhanced Services Facility (ESF) Food Service Observations and Interviews | ||
| 15-582 | Enhanced Services Facility (ESF) Exit Preparation Worksheet | ||
| 15-581 | Enhanced Services Facility (ESF) Notes / Worksheets | ||
| 15-579 | Enhanced Services Facility (ESF) Staff and Administrative Record Review | ||
| 15-578 | Enhanced Services Facility (ESF) Resident Record Review | ||
| 15-577 | Enhanced Services Facility (ESF) Environmental Observations | ||
| 15-576 | Enhanced Services Facility (ESF) Other Contact Interview | ||
| 15-575 | Enhanced Services Facility (ESF) Resident Interview | ||
| 15-574 | Enhanced Services Facility (ESF) Resident Characteristic Roster and Sample Selection |
