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 Form Name(desc) File Format
15-291 Person Centered Service Planning and Annual Assessment Meeting
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
17-180 Personal Information Release (Economic Services Administration)
11-154 Personal Pathway
17-337 Personal Service Request / Standard Referral (Behavioral Health Administration)
17-337 Personal Service Request / Standard Referral (Developmental Disabilities Administration)
10-629 Pet Record Review (Aging and Long-Term Support Administration)
09-280B Petition for Modification - Administrative Order
16-235 Photo Release
13-021 Physical Evaluation
10-573 Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination
10-648 Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration)
10-708 Planning for Youth Aged 18-21 Receiving RHDY Services (Developmental Disabilities Administration)
15-382 Positive Behavior Support Plan (PBSP)
14-538 Pre-Admission Screening and Resident Review (PASRR) Addendum
17-321 Pre-Admission Screening and Resident Review (PASRR) Equipment Purchase Request
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
11-110 Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation)
11-112 Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation)
11-106 Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation)
11-114 Pre-ETS Student Sign-In Roster (Division of Vocational Rehabilitation)
16-294 Pre-Occupancy Inspection Checklist (NH Administrator Use) (Residential Care Services)
16-287 Pre-Occupancy Inspection Checklist (Surveyor Use) (Residential Care Services)
16-288 Pre-Occupancy Worksheet: Resident Room / Bathroom (Residential Care Services)
10-268 Pre-Placement Agreement (Developmental Disabilities Administration)