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(desc) | Form Name | File Format | |
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00-398 | Phase 1 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
00-399 | Phase 2 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
00-410 | Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control Assessment (IPC) Pathway (Residential Care Services) | ||
00-411 | Adult Family Home (AFH) Assisted Living Facility (ALF) Enhanced Services Facility (ESF) Community Program Infection Prevention and Control (IPC) Assessment Pathway (Residential Care Services) | ||
00-412 | RCS (AFH, ALF, and ESF) Infection Prevention and Control (IPC) Assessment Tool for COVID-19 (Residential Care Services) (Adult Family Home, Assisted Living Facility, and Enhanced Services Facility) | ||
00-412A | RCS (AFH, ALF, and ESF) Infection Prevention and Control (IPC) Assessment Notes for COVID-19 (Residential Care Services) (Adult Family Home, Assisted Living Facility, and Enhanced Services Facility) | ||
00-413 | Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Tool for COVID-19 (Residential Care Services) | ||
00-413A | Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Notes for COVID-19 (Residential Care Services) | ||
01-110 | Protective Payee Report | ||
01-110A | Protective Payee Periodic Social Services Report | ||
01-110C | Protective Payee Report Continuation | ||
01-205 | Able Bodied Adults Without Dependents (ABAWD) Activity Report | ||
01-210 | Transmittal of Client Funds from the Protective Payee | ||
01-212 | Nurse Delegation Referral and Communication | ||
01-218 | Community Inclusion Rate Adjustment for Staffed Residential Rate | ||
02-516 | Adult Family Home Resident Personal Belongings Inventory (Residential Care Services) | ||
02-528 | Fair Hearing Withdrawal |
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02-556 | Request for Exception to Policy (ETP) for Use of Restrictive Procedures (Developmental Disabilities Administration) | ||
02-566 | Protected Health Information (PHI) Amendment | ||
02-586 | Temporary Employment Hours Tracking Log | ||
02-589 | Companion Home Outside Employment Notification and Review (Developmental Disabilities Administration) | ||
02-592 | Application for Approval of Interpreter and Translator Continuing Education Activity | ||
02-611 | Statement of Understanding: Mid-Certification Review |
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02-632 | Residential Provider's Report of Weapon Ownership in Residential Setting | ||
02-690 | Student Evaluation Summary Report | ||
02-691 | Student Class Evaluation | ||
02-692 | Community Instructor Class List Tracking Log | ||
02-709 | Adult Family Home (AFH) Personnel Changes (Aging and Long-Term Support Administration) | ||
02-714 | DSHS Virtual Classroom Training Application (Home and Community Services) | ||
02-714A | DSHS Virtual Classroom Training Application: Addendum to DSHS 02-714 (Home and Community Services) | ||
02-716 | Rapid Response Team 2 Request (Residential Care Services) (Aging and Long-Term Support Administration) | ||
02-740 | Office of Justice and Civil Rights Complaint Request |
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03-076 | Employee Personal Property Damage/Loss Claim | ||
03-077 | Release of All Claims | ||
03-133 | Safety Incident / Close Call Report | ||
03-374B | Agreement on Nondisclosure of Confidential Information - Non-Employee | ||
03-374D | ESA Non-Dislcosure of Confidential Information Agreement - Non Employee | ||
03-374E | Nondisclosure of Confidential Information Agreement for Non-Employee (eJAS Access) | ||
03-387 | DSHS Notice of Privacy Practices for Client Medical Information |
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03-387A | DSHS Notice of Privacy Practices for Client Medical Information without Acknowledgement |
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03-387B | DSHS Notice of Privacy Practices for Client Medical Information: DSHS HIPAA Covered Programs | ||
03-389A | Witness Report of Possible Client Assault (Per RCW 72.01.045, RCW 74.04.790) | ||
03-391 | Report of Possible Client Assault | ||
03-490 | Employee / Contractor Awareness IRS Safeguard Training Certification | ||
03-506 | Character, Competence, and Suitability Assessment | ||
03-509 | DSHS Unpaid Intern / Volunteer Application | ||
04-449 | Participants Feedback (Domestic Violence Intervention Treatment) | ||
04-449A | Survivors Feedback (Domestic Violence Intervention Treatment) | ||
04-452 | DSHS Community Services Survey (Community Services Division, Economic Services Administration) | ||
04-452A | DSHS Community Services Customer Survey (Community Services Division) | ||
05-010 | Rule Exception Request | ||
05-013 | Request for Hearing |
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05-246 | Notice of Action Exception to Rule (Excluding AFH) | ||
05-248 | On-Site Review (Office of Refugee and Immigrant Assistance) | ||
05-249 | Adult Residential Care Services Notice of a Change | ||
05-252 | Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation) | ||
05-254 | Federal Subminimum Wage Certificate Holder | ||
05-255 | Medicaid Transformation Project Notice of Action Exception to Rule | ||
05-256 | Notice of Action Exception to Rule for AFH Daily Rates | ||
05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment | ||
05-259 | Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment) | ||
05-260 | Change of Address for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
05-261 | Add, Change, or Remove Direct Service Staff for a Certified DVIT Program (Domestic Violence Intervention Treatment) | ||
05-262 | Add or Remove a Service for an Existing DVIT Certification (Domestic Violence Intervention Treatment) | ||
05-267 | Self-Assessment and Monitoring Tool (Home and Community Services) | ||
05-268 | Community Instructor Self-Assessment (Home and Community Services) | ||
05-269 | Community Instructor Self-Assessment for Contract Renewal and/or for Newly Established Contracts (Home and Community Services) | ||
05-272 | Case Manager Instructions Following a Hearing Decision | ||
05-273 | Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services) | ||
05-274 | Residential Referral Transition (Developmental Disabilities Administration) | ||
06-123 | Nursing Assistant Training and Testing Reimbursement | ||
06-124 | Cost of Care Adjustment (COCA) (Developmental Disabilities) | ||
06-125 | Residential Allowance Request / Insufficient Income (Developmental Disabilities Administration) | ||
06-125A | Residential Allowance Request - Start Up Costs (Developmental Disabilities Administration) | ||
06-125B | Residential Allowance Request - Damages (Developmental Disabilities Administration) | ||
06-125C | Residential Allowance Request - Shelter Expense (Developmental Disabilities Administration) | ||
06-159 | Specialized Evaluation and Consultation Provider Invoice (Developmental Disabilities Administration) | ||
06-159A | Specialized Evaluation and Treatment Provider Invoice (Developmental Disabilities Administration) | ||
06-162 | Division of Vocational Rehabilitation (DVR) Referral to Office of Financial Recovery Referral | ||
06-168 | AFH Change in Licensed Bed Capacity - Increase (Adult Family Home) (Residential Care Services) | ||
06-169 | AFH Change in Licensed Bed Capacity - Decrease (Adult Family Home) (Residential Care Services) | ||
06-171 | Funding and Expenditure Data (Tribal) | ||
06-172 | Domestic Violence Prevention Account | ||
06-173 | Medical Evidence Reimbursement | ||
06-174 | Enhanced Rate Proposal | ||
06-176 | Assisted Living Facility (ALF) Change in Licensed Resident Bed Capacity or Use of Rooms | ||
06-177 | Residential Training Roster / Reimbursement (Developmental Disabilities Administration) | ||
06-180 | Nursing Services Activity Report for Home and Community Services (HCS) | ||
06-181 | Nursing Services Activity Report for AAAs | ||
06-184 | Adult Family Home (AFH) Capacity Increase Working Papers (Residential Care Services) | ||
06-186 | Financial Solvency Information (Aging and Long-Term Support Administration) | ||
06-188 | Adult Protective Services (APS) Investigations Fact Sheet (Aging and Long-Term Support Administration) |
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06-189 | Notice of Suspension of Supported Living Services (Developmental Disabilities Administration) | ||
06-199 | Specialized Evaluation and Consultation Quarterly Report (Developmental Disabilities Administration) n | ||
06-200 | Registered Nurse (RN) Delegation Billing | ||
07-042B | Self-Employment Income Report |
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07-081 | Participation Reimbursement | ||
07-097 | Individual Provider Planned Action Notice Training / Certification (Home and Community Services) | ||
07-098 | Self Employment Monthly Sales and Expense Worksheet |
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07-103 | Basic Food Employment and Training (BFET) Participant Reimbursement |
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07-103A | Participant Reimbursement with Interpreter Declaration | ||
07-104 | Financial Communication to Social Services | ||
07-107 | Exception to Rule and Notice Guardianship Fees and Related Costs (Aging and Long-Term Support Administration and Developmental Disabilities Administration) | ||
09-004C | Voluntary Placement Agreement for Child or Youth with Developmental Disabilities | ||
09-013 | Vendor Affidavit of Lost, Stolen, or Destroyed Warrant | ||
09-052 | Affidavit of Forged Endorsement | ||
09-280B | Petition for Modification - Administrative Order |
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09-415 | Authorization for Expenditure (Non-Employee) | ||
09-508 | Waiver of Statute of Limitations |
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09-520 | Request for Conference Board |
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09-653 | Background Check Authorization | ||
09-693 | Declaration of Lawful Custody |
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09-728 | Washington State Addendum to Box 2 of Part B - Plan Administrator Response | ||
09-741 | Child Support Order Review Request |
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09-989 | Confidentiality Statement - Tribal Employee | ||
09-995 | Companion Home Certification Evaluation (Developmental Disabilities Administration) | ||
10-104B | Service Verification / Attendance Record For Alternative Living Providers (Developmental Disabilities Administration) | ||
10-210 | Staff Statement of Qualifications | ||
10-217 | Nurse Delegation: Nursing Assistant Credentials and Training | ||
10-231 | Adult Family Home (AFH) Referral Checklist (DDA) | ||
10-232 | Provider Referral Letter For Residential Services (Developmental Disabilities Administration) | ||
10-232A | AFH / ARC Provider Referral Letter | ||
10-234 | Individual with Challenging Support Issues (DDA) | ||
10-234A | Individual with Complex Behaviors (Aging and Long-Term Support Administration) | ||
10-237 | Nursing Home Transfer or Discharge Notice (Residential Care Services) | ||
10-238 | Request for an Administrative Hearing (Residential Care Services) | ||
10-244 | Child and Family Engagement Plan (Developmental Disabilities) |
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10-255 | Public Health Nurse (PHN) Summary and Recommendations | ||
10-258 | Individual With Possible Community Protection Issues (Developmental Disabilities Administration) | ||
10-268 | Pre-Placement Agreement (Developmental Disabilities Administration) | ||
10-269 | Alternative Living Services Plan and Provider Progress Report (Developmental Disabilities Administration) | ||
10-269A | Alternative Living Services Plan and Provider Progress Report Supplement to DSHS form 10-269 (Developmental Disabilities Administration) | ||
10-270 | Assisted Living Facility Admission Agreement(s) Attestation | ||
10-272 | Cross-System Crisis Plan (DDA) | ||
10-277 | Request for Children's Out-of-Home Services (Developmental Disabilities Administration) | ||
10-301 | Notification of Eligibility Review (Developmental Disabilities Administration) |
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10-326 | Staffed Residential Rate Proposal (Developmental Disabilities Administration) | ||
10-328 | Residential Site Approval Request | ||
10-329 | Informed Consent for ICAP | ||
10-331 | DDA Mortality Review Provider Report (Developmental Disabilities Administration) | ||
10-334 | Monitoring of Side Effects Scale (MOSES) (DDA) | ||
10-337 | Important Information for SSP Recipients and Their Payees (DDA) | ||
10-339 | Nursing Care Consultant (NCC) Assessment (DDA) | ||
10-348 | Community Protection Program Information Checklist and Risk Assessment Consent (Developmental Disabilities Administration) | ||
10-349 | Comprehensive Regional Review Tool | ||
10-351 | Disclosure of Services Required by RCW 18.20.300 | ||
10-353 | Documentation Request for Medical Condition and Residual Functional Capacity |
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10-359 | Assisted Living Facility Pre Inspection Preparation - Attachment A | ||
10-360 | Assisted Living Facility Request for Documentation - Attachment B | ||
10-361 | Assisted Living Facility Resident List - Attachment C | ||
10-362 | Assisted Living Facility Resident Characteristic Roster and Sample Selection - Attachment D | ||
10-362A | Assisted Living Facility Resident Characteristic Roster and Sample Selection Addendum - Attachment D | ||
10-363 | Assisted Living Facility Resident Group Meeting - Attachment E | ||
10-365 | Assisted Living Facility Resident Interview - Attachment G | ||
10-366 | Assisted Living Facility Other Contact Interview - Attachment H | ||
10-367 | Assisted Living Facility Environmental Observations - Attachment I | ||
10-368 | Assisted Living Facility Resident Record Review - Attachment J | ||
10-369 | Assisted Living Facility Staff Sample / Record Review - Attachment K | ||
10-370 | Assisted Living Facility Notes / Worksheet - Attachment L | ||
10-371 | Assisted Living Facility Exit Preparation Worksheet - Attachment M | ||
10-372 | Assisted Living Facility Contract Requirements - Attachment N | ||
10-373 | Assisted Living Facility Environmental Observations for Contract Requirements - Attachment O | ||
10-377 | Notification of Age Four (4) Eligibility Expiration- |
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10-382 | Naturalization Services Pre-Screening | ||
10-389 | Room List For Assisted Living Facilities (ALF) | ||
10-389A | Additional Room List For Assisted Living Facilities (ALF) | ||
10-393 | Cost Estimate Worksheet for Hearing Aids and Services | ||
10-396 | SSI Letter (DDA) | ||
10-400 | Information Request Letter |
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10-403 | Residential Services Provider: Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
10-412 | Adult Family Home License Relinquishment Letter | ||
10-413 | Application For Contract For Currently Licensed Assisted Living Facility | ||
10-415 | Contract Monitoring Checklist On-Site Review (Office of Refugee and Immigrant Assistance) | ||
10-417 | Adult Family Home Caregiver Experience Attestation (CEA) | ||
10-422 | Adult Family Home (AFH) Quality Improvement Initial Visit | ||
10-423 | Shared Planning for Youth Aged 18-21 Receiving Voluntary Placement Services | ||
10-424 | Voluntary Participation Statement (Developmental Disability Administration) |
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10-427 | School District Communication | ||
10-437 | Temporary Manager and/or Receiver Application Nursing Home and Assisted Living Facility | ||
10-438 | Long-Term Care Partnership (LTCP) Asset Designation | ||
10-442 | Goal Setting and Action Planning Worksheet | ||
10-448 | Nurse Delegation (ND) Contract Monitoring Chart Audit (Home and Community Services, Aging and Long Term Support Administration) | ||
10-467 | ALTSA Sentence / Copy Design Folstein MMSE (Home and Community Services) | ||
10-468 | HCS / AAA / ODHH / DDA Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults | ||
10-471 | Child and Family Team (CFT) Care Plan (Developmental Disabilities Administration) | ||
10-472 | Quality Review Tool: Functional Assessment / Positive Behavior Support Plan (Developmental Disabilities Administration) | ||
10-481 | Health Action Plan (HAP) | ||
10-486 | Assisted Living Facility Food Service Observations - Attachment P (Residential Care Facilities, Aging and Long-Term Support Administration) | ||
10-487 | Assisted Living Facility Medication Pass Worksheet - Attachment Q | ||
10-488 | Extended Foster Care Program Consent | ||
10-489 | Confidential Health Information Consent Agreement |
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10-501 | Referral to DSHS for Basic Food Employment and Training (BFET) | ||
10-503 | Limitation Extension Evaluation | ||
10-504 | Limitation Extension Request for Clients Under Age 21 | ||
10-505 | Limitation Extension Task Explanation | ||
10-506 | Limitation Extension Request Checklist | ||
10-508 | Adult Family Home Disclosure of Services Required by RCW 70.128.280 | ||
10-509 | Pediatric Symptoms Checklist (PSC-17) | ||
10-535 | Enhanced Services Facility Application | ||
10-570 | Intake and Referral | ||
10-571 | Overnight Planned Respite Services Individualized Agreement | ||
10-572 | Planned Respite Application (Developmental Disabilities Administration) | ||
10-573 | Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination | ||
10-574 | Transitional Care Planning Tracking (Developmental Disabilities Administration) | ||
10-574A | Transitional Care Planning Tracking: Part A. Transition Preparation (Developmental Disabilities Administration) | ||
10-574B | Transitional Care Planning Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration) | ||
10-574C | Transitional Care Planning Tracking: Part C. Post Move and Stabilization (Developmental Disabilities Administration) | ||
10-577 | Assisted Living Facility Other Contact Information - Attachment R | ||
10-580 | Adult Day Services Referral | ||
10-583 | DDA PASRR Cover Sheet | ||
10-584 | Data Summary Report and Recommendations (Developmental Disabilities Administration) | ||
10-585 | Adult Family Home Information Changes | ||
10-589 | Comprehensive Functional Assessment of Recreation | ||
10-590 | Comprehensive Functional Assessment of Physical Therapy | ||
10-591 | Assisted Living Facility License Application | ||
10-592 | Comprehensive Functional Assessment of Direct Care Independent Living Skills | ||
10-594 | Comprehensive Functional Assessment of Communication | ||
10-595 | Comprehensive Functional Assessment of Occupational Therapy | ||
10-596 | Comprehensive Functional Assessment of Adult Training Programs | ||
10-601 | Assisted Living Facility Information Changes | ||
10-602 | Enhanced Services Facility Information Changes | ||
10-603 | Nursing Home Information Changes | ||
10-604 | Supported Living Information Changes (Residential Care Services) | ||
10-605 | ICF / IID Information Changes (Residential Care Services) | ||
10-611 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Face Sheet (Residential Care Services) | ||
10-613 | Community Residential Services and Supports (CCRSS) Certification Evaluation Client Supports Observation (Residential Care Services) | ||
10-614 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Interview (Residential Care Services) | ||
10-615 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Family / Representative / Collateral Contact Interview (Residential Care Services) | ||
10-616 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Staff Interview (Residential Care Services) | ||
10-617 | Certified Community Residential Services and Supports (CCRSS) Home Environment and Safety Worksheet (Residential Care Services) | ||
10-617A | Certified Community Residential Services and Supports (CCRSS) Group Training Home (GTH) Home Environment and Safety Worksheet | ||
10-618 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Staff Sample / Record Review (Residential Care Services) | ||
10-619 | Certified Community Residential Services and Supports (CCRSS) Background Check Record Review (Residential Care Services) | ||
10-620 | Certified Community Residential Services and Supports (CCRSS) Residential Cost Report – ISS Hours Review / Questionnaire (Residential Care Services) | ||
10-621 | Certified Community Residential Services and Supports (CCRSS) Notes (Residential Care Services) | ||
10-622 | Certified Community Residential Services and Supports (CCRSS) Group Training Home Food Service Observations and Interviews (Residential Care Services) | ||
10-623 | DDA PASRR Significant Change Invalidation (Developmental Disabilities Administration) (Pre-Admission Screening and Resident Review) | ||
10-625 | State Task Checklist (Aging and Long-Term Support Administration) | ||
10-626 | Staffing Pattern (Aging and Long-Term Support Administration) | ||
10-627 | Liability Insurance Review (Aging and Long-Term Support Administration) | ||
10-628 | Trust Fund Review (Aging and Long-Term Support Administration) | ||
10-629 | Pet Record Review (Aging and Long-Term Support Administration) | ||
10-630 | Paid Feeding Assistant Program Review (Aging and Long-Term Support Administration) | ||
10-631 | Staff Qualification and Background Review (Aging and Long-Term Support Administration) | ||
10-632 | TB Testing Review for Staff (Aging and Long-Term Support Administration) | ||
10-633 | TB Testing Review for Resident (Aging and Long-Term Support Administration) | ||
10-634 | Medication Assistant Endorsement (Aging and Long-Term Support Administration) | ||
10-635 | Residential Transition Exchange of Information (Developmental Disabilities Administration) | ||
10-636 | Meaningful Day Monthly Calendar | ||
10-637 | Meaningful Activity Plan (MAP) Discovery | ||
10-638 | AFH Meaningful Day - Monthly Activities and Challenging Behavior Log | ||
10-639 | Overnight Planned Respite Services (OPRS) Certification Evaluation (Developmental Disabilities Administration) | ||
10-640 | Emphasis on Hands-On Skills Practice: Planning Attestation (Home and Community Services) | ||
10-641 | Community Instructor Qualification Tool (Home and Community Services) | ||
10-642 | Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services) | ||
10-643 | PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
10-644 | Home and Community-Based Services (HCBS) Waiver Approval Notification (DDA) |
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10-645 | Residential Certification Evaluation Client Interview (Developmental Disabilities Administration) | ||
10-646 | Residential Certification Evaluation Legal Representative Interview (Developmental Disabilities Administration) | ||
10-647 | Residential Certification Evaluation Staff Interview (Developmental Disabilities Administration) | ||
10-648 | Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
10-649 | Children's State Operated Living Alternatives (SOLA) Certification Evaluation (Developmental Disabilities Administration) | ||
10-650 | Private Duty Nursing (PDN) Contract Monitoring Tool (Home and Community Services) | ||
10-650A | Adult Family Home (AFH) Private Duty Nursing (PDN) Contract Monitoring Tool (Home and Community Services) | ||
10-653 | State Civil Penalty Reinvestment Program Grant (SCPRP) Community Residential Services and Supports (CCRSS) Grant Application | ||
10-655 | Initial Staff and Family Consultation Plan (Developmental Disabilities Administration) |
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10-656 | Staff and Family Consultation (SFC) 90-Day (Quarterly) Progress Report (Developmental Disabilities Administration) |
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10-657 | Initial Specialized Habilitation Plan (Developmental Disabilities Administration) |
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10-658 | Specialized Habilitation 90-Day (Quarterly) Report (Developmental Disabilities Administration) |
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10-659 | Initial Community Engagement Plan (Developmental Disabilities Administration) | ||
10-659 | Initial Community Engagement Plan (Developmental Disabilities Administration) | ||
10-660 | Community Engagement Quarterly Progress Report (Developmental Disabilities Administration) |
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10-661 | Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
10-662 | Equine Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
10-663 | Existing Companion Home (CH) Movers Checklist (Developmental Disabilities Administration) | ||
10-664 | New or Update Provider Information Worksheet (Developmental Disabilities Administration) | ||
10-665 | Alternative Living Provider Application (Developmental Disabilities Administration) | ||
10-666 | Residential Quality Assurance Certification Evaluation Checklist for Overnight Planned Respite Services Providers (Developmental Disabilities Administration) | ||
10-668 | PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration) | ||
10-669 | Out-of-Home Services (OHS) Transition Checklist (Developmental Disabilities Administrations) | ||
10-670 | Nursing Home Facility License Application (Aging and Long-Term Support Administration) | ||
10-671 | Intensive Habilitation Services for Children Certification Evaluation (Developmental Disabilities Administration) | ||
10-673 | Request for ICF/IID or SONF Services at an RHC Administration Application | ||
10-676 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Finances Record Review | ||
10-677 | Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Client Record Review | ||
10-678 | Stabilization, Assessment, and Intervention Facility (SAIF) Program Evaluation (Developmental Disabilities Administration) | ||
10-679 | Alternative Living Provider Application, Contracting, and Certification Overview Checklist (Developmental Disabilities Administration) | ||
10-680 | Certified Community Residential Services and Supports (CCRSS) Packet (Aging and Long-Term Support Administration) | ||
10-681 | Group Training Home (GTH) Certified Community Residential Services and Supports (CCRSS) Packet (Aging and Long-Term Support Administration) | ||
10-682 | Intensive Habilitation Services (IHS) Habilitation Plan (Developmental Disabilities Administration) | ||
10-683 | Enhanced Services Facility (ESF) Follow-Up (Residential Care Services) | ||
10-685 | Companion Home Provider Supplemental Information (Developmental Disabilities Administration) | ||
10-687 | DDA Specialty Adult Family Home (AFH) Pilot: Strengths, Abilities, Interests, Learn (SAIL) (Developmental Disabilities Administration) | ||
10-688 | DDA Specialty Adult Family Home (AFH) Pilot Monthly Client Goal and Progress Report (Developmental Disabilities Administration) | ||
10-689 | Assisted Living Facility Monitoring Visit (Residential Care Services) | ||
10-690 | Nursing Care Consultant Transition Tool (Developmental Disabilities Administration) | ||
10-691 | Certified Community Residential Services and Supports (CCRSS) Client Characteristics (Residential Care Services) | ||
11-019 | Vocational Information (Division of Vocational Rehabilitation) | ||
11-022 | Application for Vocational Rehabilitation Services | ||
11-030 | Service Delivery Outcome Report (Community Rehabilitation Program - CRP) | ||
11-034B | Basic Food Eligibility Requirements: What You Need to Know |
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11-058 | Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation) | ||
11-066 | Assistive Communication Technology Request (Office of Deaf and Hard of Hearing) | ||
11-067 | Monthly Budget Worksheet (Division of Vocational Rehabilitation) | ||
11-068 | Customer Internship Program Internship Application (Division of Vocational Rehabilitation) |
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11-069 | DVR Internship Agreement (Division of Vocational Rehabilitation) |
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11-070 | DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation) | ||
11-071 | DVR Employer Expense Worksheet (Division of Vocational Rehabilitation) | ||
11-084 | Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation) | ||
11-088 | DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet | ||
11-097 | Service Delivery Outcome Report (Independent Living Services - IL) | ||
11-098 | Vocational Assessment Worksheet |
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11-106 | Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation) | ||
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) | ||
11-114 | Student Workshop Roster | ||
11-118 | Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation) | ||
11-119 | Informational Interview Worksheet (Division of Vocational Rehabilitation) | ||
11-121 | Enhanced Case Management Referral Consideration (Developmental Disabilities Administration) | ||
11-123 | Service Delivery Outcome Plan: WBL - Experience A | ||
11-124 | Service Delivery Outcome Plan: WBL - Experience B | ||
11-125 | Service Delivery Outcome Plan: WBL - Experience C | ||
11-130 | Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services) | ||
11-132 | 90 Day Review (Division of Vocational Rehabilitation) | ||
11-133 | Jobs and Training Inventory (Division of Vocational Rehabilitation) | ||
11-134 | Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation) | ||
11-142 | Service Delivery Outcome Plan: Pre-ETS IL Skills Training | ||
11-146 | Supported Employment Referral (Economic Services Administration) |
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11-149 | Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet | ||
11-152 | Forensic Navigator to Inpatient - Referral Information Form (RIF) (Office of Forensic Mental Health Services) | ||
11-153 | Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services) | ||
11-154 | Personal Pathway | ||
11-163 | Applicant Certification and Assurances (Division of Vocational Rehabilitation) | ||
11-164 | Community Rehabilitation Program (CRP) Services and Qualifications (Division of Vocational Rehabilitation) | ||
11-165 | Independent Living (IL) Services and Qualifications (Division of Vocational Rehabilitation) | ||
11-167 | Internship: Employer Evaluation | ||
11-168 | Internship: Customer Evaluation | ||
11-180 | Discovery Profile Report (Developmental Disabilities Administration) | ||
12-195 | Disqualification Consent Agreement | ||
12-206 | Application for Disaster Food Benefits | ||
12-207 | Application for Disaster Cash Assistance | ||
12-209 | Client Fraud Report | ||
12-210 | Medicaid Provider Fraud Report | ||
12-212 | Waiver of Administrative Disqualification Hearing (Community Services Division) | ||
13-021 | Physical Evaluation | ||
13-585A | Range of Joint Motion Evaluation Chart | ||
13-645 | Adult Family Home Injuries and Accidents Log | ||
13-678 Page 1 | Nurse Delegation: Consent for Delegation Process | ||
13-678 Page 2 | Nurse Delegation: Instructions for Nursing Task | ||
13-678A | Nurse Delegation: PRN Medication | ||
13-678B | Nurse Delegation: Assumption of Delegation | ||
13-680 | Nurse Delegation: Rescinding Delegation | ||
13-681 | Nurse Delegation: Change in Medical Orders | ||
13-692A | Assisted Living Facility (ALF) Dementia Screening Tool | ||
13-712 | Behavioral Health Personal Care (BHPC) Request for MCO Funding (Aging and Long-Term Support Administration) | ||
13-713 | Fast Track Service Agreement |
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13-738 | DDA / DCYF Request to Cost Share (Developmental Disabilities Administration) (Department of Children, Youth, and Families) | ||
13-776 | HCS / AAA Nursing Services Referral (Home and Community Services) | ||
13-780 | Nursing Services Basic Skin Assessment (Home and Community Services) | ||
13-783 | Pressure Injury Assessment and Documentation (Home and Community Services) | ||
13-784 | Nursing Services Assessment | ||
13-851 | Psychiatric Referral Summary | ||
13-865 | Psychological / Psychiatric Evaluation | ||
13-893 | Nurse Delegation: Request For Additional Units | ||
13-899 | Review of Medical Evidence | ||
13-903 | DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration) | ||
13-906 | Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services) | ||
13-911 | DDA Nursing Service Referral (Developmental Disabilities Administration) | ||
13-915 | Information for Respite Care Service Providers: Addendum to TCARE Assessment (Aging and Long-Term Support Administration) | ||
13-917 | Intensive Habilitation Services (IHS) Medical / Dental Services Authorization (Developmental Disabilities Administration) | ||
13-919 | Weekly Status Update (Competency Restoration Program) (Behavioral Rehabilitation Administration) | ||
13-920 | Outpatient Competency Restoration Program (OCRP) Discharge Summary | ||
13-925 | Request for Formulary Admission or Deletion (Behavioral Health Administration) | ||
13-925A | Non-Formulary Drug Use Request (Behavioral Health Administration) | ||
13-926 | Forensic (6358) Consultation (Behavioral Health Administration) | ||
13-927 | Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration) | ||
13-928 | Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration) | ||
13-935 | State Hospital Triage Consultation and Expedited Admission (TCEA) Request | ||
13-936 | Stabilization, Assessment, and Intervention Services (SAIF) Eligibility and Referral (Developmental Disabilities Administration) | ||
14-001 | Application for Cash or Food Assistance |
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14-012 | Consent |
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14-050 | Statement of Health, Education, and Employment | ||
14-057 | Child Support Referral |
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14-057B | Noncustodial Parent Child Support Enforcement Application | ||
14-057D | Child Support Referral Continuation | ||
14-068 | Financial Statement (Division of Vocational Rehabilitation) |
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14-076 | Change of Circumstances |
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14-078 | Eligibility Review | ||
14-084 | Social Service Referral | ||
14-105 | Interview Appointment for Applicant (Community Services Division) |
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14-113 | Your Cash and Food Assistance Rights and Responsibilities |
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14-144A | Medical Disability Decision |
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14-151 | Request for DDA Eligibility Determination |
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14-155 | Senior Citizens Service Application | ||
14-223 | Statement from School | ||
14-224 | Statement from Landlord/Manager |
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14-225 | Acknowledgement of Services |
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14-238 | Client Income Report | ||
14-252 | Employment Verification |
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14-264 | Application for Telecommunications Equipment | ||
14-299 | Adult Assessment Referral (Economic Services Administration) | ||
14-300 | Level One Pre-Admission Screening and Resident Review (PASRR) | ||
14-310 | Client Status Change Report | ||
14-332 | Disability Assessment | ||
14-341 | Application to Convert Payment Services Only (PSO) Case to Full Collection Services | ||
14-349 | Protective Payee Assessment |
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14-381 | WorkFirst Individual Responsibility Plan |
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14-401 | Notification of Address Disclosure Request - Part 1 | ||
14-401A | Notification of Address Disclosure Request - Part 2 | ||
14-402 | Notice to Parents (WorkFirst) |
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14-416 | Eligibility Review for Long Term Services and Supports |
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14-426 | Protective Payee Payment Plan, Case Assignment, and Closure Notice |
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14-427 | Teen Parent Living Assessment | ||
14-431 | Medical / Dental Services Authorization (Voluntary Placement Services) (Developmental Disabilities Administration) | ||
14-431A | Community Crisis Stabilization Services (CCSS) Medical / Dental Services Authorization (Developmental Disabilities Administration) | ||
14-432 | Direct Deposit Enrollment | ||
14-436 | Statement of Adult Acting in Loco Parentis (As a Parent) |
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14-438 | Stop Work |
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14-439 | Washington State Combined Application Program (WASHCAP) Application | ||
14-440 | Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing) | ||
14-443 | Financial / Social Services Communication | ||
14-449 | Unmet Need Breakdown | ||
14-453 | Protective Payee Decision | ||
14-454 | Estate Recovery: Repaying the State for Medical and Long Term Services and Supports |
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14-459 | Eligible Conditions With Age and Type of Evidence (Developmental Disabilities Administration) |
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14-460 | Notice of Insufficient Information (Developmental Disabilities Administration) |
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14-462 | Epilepsy Verification Request (Developmental Disabilities Administration) | ||
14-463 | Waiver Transportation Record (DDA) | ||
14-465 | Sources for Eligibility Information (Developmental Disabilities Administration) | ||
14-467 | Mid-Certification Review |
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14-473 | Inventory for Client and Agency Planning (ICAP) Letter | ||
14-475 | Appointment Letter for Division of Child Support (DCS) Good Cause Determination |
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14-478 | Aged, Blind, or Disabled (ABD) Program Medical Treatment Participation |
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14-484 | Nurse Delegation: Nursing Visit | ||
14-489 | SSIF Introduction Letter |
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14-491 | NSA Representative Checklist forDDA Review | ||
14-492 | Assessment Meeting Wrap-up |
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14-493 | Requirement to Identify a Representative (Developmental Disabilities Administration) | ||
14-495 | Naturalization Letter |
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14-501 | Community Resource Declaration | ||
14-503 | Interim Assistance Reimbursement Agreement Cover |
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14-514 | Your Responsibility to Pay Towards Costs of Care at the Residential Habilitation Center |
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14-515 | Notice and Finding of Responsibility |
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14-517 | DSHS Letter Requesting Non Work SSN | ||
14-520 | Your DSHS Cash or Food Assistance Benefits |
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14-521 | Your Rights (Home and Community Services) |
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14-525 | Incapacity Review for Medical Care Services |
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14-526 | ABD and HEN Referral Substance Use Treatment Verification | ||
14-527 | Substance Use Disorder Requirements (HEN Referral Program) |
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14-528 | Substance Use Good Cause Appointment Letter (HEN Referral) | ||
14-529 | Substance Use Disorder Requirements (ABD / PWA) | ||
14-530 | Disability Review |
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14-532 | Authorized Representative |
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14-534 | SDCP Eligibility Checklist (Home and Community Services) | ||
14-535 | Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration) | ||
14-538 | Pre-Admission Screening and Resident Review (PASRR) Addendum | ||
14-541 | ABAWD Requirement: Medical Report (Able Bodied Adults without Dependents) | ||
14-542 | Application for New Program Certification (Domestic Violence Intervention Treatment) | ||
14-543 | Application for Renewal Program Certification (Domestic Violence Intervention Treatment) | ||
14-544 | Continuing Education Summary for DVPT Providers (Domestic Violence Intervention Treatment) | ||
14-547 | Continuing Care Retirement Community (CCRC) Registration Application | ||
14-549 | DDA Companion Home Provider Application (Developmental Disabilities Administration) | ||
14-550 | Job Foundation Application (Developmental Disabilities Administration) | ||
14-551 | Adult Family Homes (AFH) State Civil Penalty Reinvestment Program Grant Application | ||
14-552 | TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing) | ||
14-553 | High School Home Care Aide Training Program and Instructor Application and Updates (Aging and Long-Term Support Administration) | ||
15-031 | Nursing Facility Notice of Action | ||
15-184 | Volunteer Chore Service Referral | ||
15-215 | AFH Quality Improvement Visit Assessment | ||
15-274 | Assistance Available Schedule (DDA) | ||
15-282A | Request for Enrollment in Developmental Disabilities Administration (DDA) Home and Community Based Services (HCBS) Waiver or Request to Change from One DDA HCBS Waiver to Another | ||
15-290 | Notification of Annual Assessment Review and Person Centered Services Planning Meeting | ||
15-291 | Person Centered Service Planning and Annual Assessment Meeting |
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15-295 | Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration) | ||
15-304 | HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration) |
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15-314 | Client Necessary Supplemental Accommodation Representative Requirement Checklist | ||
15-318 | DDA Crisis Diversion Bed Referral and Intake Information | ||
15-331 | Annual Assessment Checklist (Developmental Disability Administration) | ||
15-342 | Notice of Exception to Rule Decision | ||
15-344 | Private Duty Nursing Logs and Skilled Nursing Tasks Log | ||
15-356 | DDA Community Protection Program Chaperone Agreement | ||
15-358 | Client Referral Summary (Developmental Disabilities Administration) | ||
15-360 | Residential Services Capacity Profile | ||
15-365 | Community Protection Treatment Worksheet Quarterly Review | ||
15-366 | Change of Address | ||
15-376 | Skin Observation Protocols | ||
15-379 | Staff Add-on Request for Client Specific Need (Developmental Disabilities Administration)) | ||
15-380 | Individual and Family Services Assessment Worksheet (Developmental Disabilities Administration) | ||
15-381 | Respite Assessment Worksheet | ||
15-382 | Positive Behavior Support Plan (PBSP) | ||
15-383 | Functional Behavioral Assessment (FA) | ||
15-384 | Provider Progress Report of Behavior Management and Consultation and Staff/Family Training and Consultation Services (DDA) | ||
15-385 | Provider Consent For Use of Restrictive Procedures Requiring an ETP | ||
15-387 | Children’s Respite Application | ||
15-388 | Alternative Living Certification Evaluation (Developmental Disabilities Administration) | ||
15-389 | Certified Community Residential Services and Support (CCRSS) Initial Application | ||
15-398 | Medically Intensive Children's Program (MICP) Application | ||
15-419 | Refusal of Services Statement | ||
15-422 | No Paid Services Group |
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15-424 | Staffed Residential Cost of Care Adjustment Request | ||
15-429A | Notice of Decision on Request for School Break Personal Care Exception to Rule | ||
15-435 | Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration | ||
15-436 | Request for Adult Family Home Application Fee Waiver | ||
15-447 | Resident Choice Regarding Assisted Living Facility (ALF) Room Requirements (Home and Community Services) | ||
15-449 | Adult Family Home Disclosure of Charges Required by RCW 70.128.280 | ||
15-456 | RCS Character, Competence and Suitability (CSS) Determination for Unsupervised Access to Minors and Vulnerable Adults | ||
15-458 | Adult Family Home Notice of Transfer or Change | ||
15-483 | Notification Regarding Request to Exceed Work Week Limit (Home and Community Services) - TRANSLATIONS ONLY | ||
15-492 | Medicaid Transformation Project Service Notice | ||
15-493 | PASRR Client Referral | ||
15-494 | Residential Habilitation Center (RHC) / Individual Habilitation Plan (IHP) / Individual Plan of Care (IPOC) Meeting Notification (Developmental Disabilities Administration) | ||
15-501 | Notification of Initial Assessment Request (Developmental Disabilities Administration) | ||
15-512 | Companion Home and Alternative Living Services Incident Report (Developmental Disabilities Administration) | ||
15-514 | Companion Home (CH) Client Individual Financial Plan (IFP) (Developmental Disabilities Administration) | ||
15-515 | CCSS Family Agreement (Community Crisis Stabilization Services) (Developmental Disabilities Administration) | ||
15-516 | Companion Home Quarterly Report (Developmental Disabilities Administration) | ||
15-517 | Application for Transition from Group Home to Group Training Home | ||
15-547 | Continuing Education Event Approval Application (Aging and Long-Term Support Administration) | ||
15-548 | Adult Family Home Administrator Training Instructor Application (Home and Community Services) | ||
15-549 | Community Instructor Application: DSHS Adult Education (Home and Community Services) | ||
15-550 | Community Instructor Application (Home and Community Services) | ||
15-551 | Community Instructor Training Program Application and Updates (Home and Community Services) | ||
15-552 | Curriculum Approval Application (Home and Community Services) | ||
15-554 | Facility Instructor Application (Home and Community Services) | ||
15-555 | Facility Training Program Application and Updates (Home and Community Services) | ||
15-556 | Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration) | ||
15-558 | Adult Family Home (AFH) Resident Significant Change Assessment Request | ||
15-559 | Adult Family Home Referral Request (Developmental Disabilities Administration) | ||
15-560 | Room Requirements Checklist (Home and Community Services) | ||
15-564 | Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration) | ||
15-565 | Nursing Home (NH) Complaint Investigation (CI) Skill Building Tool | ||
15-567 | On-the-Job Facility Training Plan Application and Updates (Home and Community Services) | ||
15-568 | DDA Alternative Living Provider Orientation (Developmental Disabilities Administration) | ||
15-569 | Notice of Termination of Service (Developmental Disabilities Administration) | ||
15-571 | Enhanced Services Facility (ESF) Pre-Inspection Preparation | ||
15-572 | Enhanced Services Facility (ESF) Request for Documentation | ||
15-573 | Enhanced Services Facility (ESF) Resident List | ||
15-574 | Enhanced Services Facility (ESF) Resident Characteristic Roster and Sample Selection | ||
15-575 | Enhanced Services Facility (ESF) Resident Interview | ||
15-576 | Enhanced Services Facility (ESF) Other Contact Interview | ||
15-577 | Enhanced Services Facility (ESF) Environmental Observations | ||
15-578 | Enhanced Services Facility (ESF) Resident Record Review | ||
15-579 | Enhanced Services Facility (ESF) Staff and Administrative Record Review | ||
15-581 | Enhanced Services Facility (ESF) Notes / Worksheets | ||
15-582 | Enhanced Services Facility (ESF) Exit Preparation Worksheet | ||
15-583 | Enhanced Services Facility (ESF) Food Service Observations and Interviews | ||
15-584 | Enhanced Services Facility (ESF) Medication Pass Worksheet | ||
15-585 | Enhanced Services Facility (ESF) Staff Schedule Worksheet (Residential Care Services) | ||
15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
15-585B | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 12-hour Shift (Residential Care Services) | ||
15-586 | Enhanced Services Facility (ESF) Inspection Packet | ||
15-589 | Adult Family Home (AFH) Initial Licensing Inspection (Residential Care Services) | ||
15-589A | Adult Family Home (AFH) LIcensing Inspection Floor Plan "Key" (Residential Care Services) | ||
15-589B | Adult Family Home (AFH) Licensing: Resident Bedroom / Bathroom Worksheet Continuation (Residential Care Services) | ||
15-589C | Adult Family Home (AFH) Relocation Initial Licensing Inspection (Residential Care Services) | ||
15-591 | High School Home Care Aide Instructor Application (Home and Community Services) | ||
15-593 | 21-Day Competency Check Request (Behavioral Health Administration) | ||
15-594 | Private Duty Nursing (PDN) Care Plan (Aging and Long-Term Services Administration) | ||
15-595 | Intensive Habilitation Services (IHS) Behavior Intervention Plan (Developmental Disabilities Administration) | ||
15-596 | Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Referral (Home and Community Services) | ||
16-072 | NonAssistance Support Enforcement Information (Division of Child Support) |
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16-107 | Noncustodial Parent's Rights and Responsibilities |
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16-172 | Your Rights and Responsibilities When You Receive Services Offered by Aging and Disability Services Administration and Developmental Disabilities Administration |
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16-182 | Guidelines for Completing the ICAP / SIB-R Adaptive Behavior Scale (Developmental Disabilities Administration) | ||
16-191 | SOLA Vehicle Trip Log (Developmental Disabilities Administration) | ||
16-193 | Nurse Aide Registry Inquiry (ADSA) | ||
16-195 | Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative |
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16-197 | Assisted Living Facility Policies and Procedures Attestation | ||
16-199 | New Case/Resource Manager Technology Training Checklist | ||
16-201 | New Case / Resource Manager Assessment (Developmental Disabilities Administration) |
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16-202 | 5-Day Investigation Report (Developmental Disabilities Administration (DDA) | ||
16-202A | Corrective Action Plan (5-Day Investigation) (Developmental Disabilities Administration) | ||
16-203 | SIS-A Rating Key (Developmental Disabilities Administration) | ||
16-213 | Verification of Legal Status | ||
16-218 | Intake Cover Letter to Tribes | ||
16-230 | Children's Residential Services | ||
16-234 | Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF) | ||
16-234A | Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC)) | ||
16-235 | Photo Release | ||
16-237 | DDA GovDelivery Communication Request (Developmental Disabilities Administration) | ||
16-242 | Ask DSHS |
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16-243 | Community Services Office (CSO) Compliments and Concerns (Economic Services Administration) | ||
16-244 | New Freedom Participant Responsibility Agreement | ||
16-245 | Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services) |
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16-246 | Your rights as a client of the Developmental Disabilities Administration |
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16-247 | Your Rights and Responsibilities When You Receive MAC or TSOA Services Offered by ALTSA | ||
16-253 | For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services) | ||
16-255 | For Field Use Only: Sex Offender Notification to Facility (Home and Community Services) | ||
16-262 | Individual Integrated Settings Checklist for Residential Providers (Optional) (Developmental Disabilities Administration) |