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 | |
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17-260 | Companion Home Gift Card or Pre-paid Credit Card Ledger (Developmental Disabilities Administration) | ||
17-259 | Companion Home Client Inventory Record | ||
17-257 | Companion Home Client Budget Worksheet (Developmental Disabilities Administration) | ||
17-231 | Mental Incapacity Evaluation (MIE) Contractor Travel Plan | ||
17-230 | Non-Emergency Medical Transportation (NEMT) for PASRR Program Request | ||
17-229 | Pre-Admission Screening and Resident Review (PASRR) Records Request | ||
17-226 | AAA DSHS / HCS Systems Access Request (Aging and Long-Term Support Administration) | ||
17-211 | Authorization for SSI Facilitation Records (Economic Services Administration) | ||
17-208A | PRISM Access Request for Multiple Organizations | ||
17-194 | Request for Mental Health Service Information | ||
17-180 | Personal Information Release (Economic Services Administration) | ||
17-123 | Spoken Language Interpreter Service Appointment Record | ||
17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
17-063 | Authorization |
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17-041 | Request for Records |
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17-011 | Forms and Publications Request | ||
16-276 | Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS)) | ||
16-275 | Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services) | ||
16-274 | Exhibit B: School-to-Work County Mentorship Program Monthly Tracking and Reporting (Division of Vocational Rehabilitation) | ||
16-273 | Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration) | ||
16-267 | Integrated Settings Review for Resource Managers (Developmental Disabilities Administration) | ||
16-266 | Integrated Settings Survey: Employment or Community Inclusion Settings (Developmental Disabilities Administration) | ||
16-265 | Integrated Settings Survey: Other Settings (Developmental Disabilities Administration) | ||
16-262 | Individual Integrated Settings Checklist for Residential Providers (Optional) (Developmental Disabilities Administration) | ||
16-255 | For Field Use Only: Sex Offender Notification to Facility (Home and Community Services) |