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.

Choose search option and begin typing the form #
Keyword Search
Number(asc) Form Name File Format
27-240 Medicaid Provider Disclosure Statement for Nursing Facility
27-234 CCLS Small Business Self-Certification Statement
27-233 CCLS General Terms and Conditions (GTC) Change Request
27-232 CCLS DES Late Filing Justification
27-231 CCLS Source Contract Justification
27-230 CCLS Emergency Contract Justification
27-229 CCLS Sole Source Amendment Justification
27-228 CCLS Additional Delegated Authority Request
27-226 Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services)
27-223 Adult Family Home Policies and Procedures Attestation
27-222 Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application
27-221 DSHS Claim of Stolen EBT Benefits
27-220 Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration)
27-219 Death Notification Checklist for Medical Providers (Developmental Disabilities Administration)
27-218 Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration)
27-215 Teleservice Agreement (Developmental Disabilities Administration)
27-210 DDA Authorization for Release of Referral Video (Developmental Disabilities Administration)
27-209 Nursing Home Informal Dispute Resolution Request (Residential Care Services)
27-208 Declaration to Adult Protective Services
27-207 Acknowledgement Statement (Meaningful Day) (Home and Community Services)
27-194 Complimentary Therapies Agreement (Developmental Disabilities Administration)
27-194 Complimentary Therapies Agreement (Developmental Disabilities Administration)
27-189 Asset Verification Authorization (Home and Community Services)
27-188 Initial Opiate Prescription Informed Consent (Behavioral Health Administration)
27-182 DSHS Request for Positive Identification – Thumbprint