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 | |
---|---|---|---|
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) | ||
15-595 | Intensive Habilitation Services (IHS) Behavior Intervention Plan (Developmental Disabilities Administration) | ||
13-917 | Intensive Habilitation Services (IHS) Medical / Dental Services Authorization (Developmental Disabilities Administration) | ||
10-671 | Intensive Habilitation Services for Children Certification Evaluation (Developmental Disabilities Administration) | ||
14-105 | Interview Appointment for Applicant (Community Services Division) |
|
|
18-464 | Introduction to New Hire Reporting | ||
14-473 | Inventory for Client and Agency Planning (ICAP) Letter | ||
13-927 | Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration) | ||
11-133 | Jobs and Training Inventory (Division of Vocational Rehabilitation) | ||
05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment | ||
10-627 | Liability Insurance Review (Aging and Long-Term Support Administration) | ||
10-504 | Limitation Extension Request for Clients Under Age 21 | ||
19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
|
|
27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
27-240 | Medicaid Provider Disclosure Statement for Nursing Facility | ||
12-210 | Medicaid Provider Fraud Report | ||
05-255 | Medicaid Transformation Project Notice of Action Exception to Rule | ||
15-492 | Medicaid Transformation Project Service Notice | ||
14-431 | Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration) | ||
10-634 | Medication Assistant Endorsement (Aging and Long-Term Support Administration) | ||
17-231 | Mental Incapacity Evaluation (MIE) Contractor Travel Plan | ||
10-334 | Monitoring of Side Effects Scale (MOSES) (DDA) |