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 | |
|---|---|---|---|
| 15-582 | 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 | ||
| 15-576 | Enhanced Services Facility (ESF) Other Contact Interview | ||
| 15-572 | Enhanced Services Facility (ESF) Request for Documentation | ||
| 15-569 | Notice of Termination of Service (Developmental Disabilities Administration) | ||
| 15-568 | DDA Alternative Living Provider Orientation (Developmental Disabilities Administration) | ||
| 15-564 | Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration) | ||
| 15-556 | Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration) | ||
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 15-551 | Community Instructor Training Program Application and Updates (Home and Community Services) | ||
| 15-550 | Community Instructor Application (Home and Community Services) | ||
| 15-549 | Community Instructor Application: DSHS Adult Education (Home and Community Services) | ||
| 15-548 | Adult Family Home Administrator Training Instructor Application (Home and Community Services) | ||
| 15-547 | Continuing Education Event Approval Application (Aging and Long-Term Support Administration) | ||
| 15-517 | Application for Transition from Group Home to Group Training Home | ||
| 15-516 | Companion Home Quarterly Report (Developmental Disabilities Administration) | ||
| 15-512 | Companion Home and Alternative Living Services Incident Report (Developmental Disabilities Administration) | ||
| 15-501 | Notification of Initial Assessment Request (Developmental Disabilities Administration) | ||
| 15-494 | Residential Habilitation Center (RHC) / Individual Habilitation Plan (IHP) / Individual Plan of Care (IPOC) Meeting Notification (Developmental Disabilities Administration) | ||
| 15-492 | Medicaid Transformation Project Service Notice | ||
| 15-458 | Adult Family Home Notice of Transfer or Change | ||
| 15-456 | RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults | ||
| 15-449 | Adult Family Home Disclosure of Charges Required by RCW 70.128.280 |
