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(desc) | File Format | |
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15-291 | Person Centered Service Planning and Annual Assessment Meeting |
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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 |
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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) |