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.

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Number(asc) Form Name File Format
16-266 Integrated Settings Survey: Employment or Community Inclusion Settings (Developmental Disabilities Administration)
16-265 Integrated Settings Survey: Other Settings (Developmental Disabilities Administration)
16-264 Integrated Settings Survey: Residential Settings (Developmental Disabilities Administration)
16-263 Integrated Settings Provider Self-Assessment Residential 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)
16-253 For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services)
16-247 Your Rights and Responsibilities When You Receive MAC or TSOA Services Offered by ALTSA
16-246 Your rights as a client of the Developmental Disabilities Administration
16-245 Skills Practice Procedure Checklist for Home Care Aides DSHS Approved (Home and Community Services)
16-244 New Freedom Participant Responsibility Agreement
16-243 Community Services Office (CSO) Compliments and Concerns (Economic Services Administration)
16-242 Ask DSHS
16-237 DDA GovDelivery Communication Request (Developmental Disabilities Administration)
16-235 Photo Release
16-234A Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC))
16-234 Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF)
16-230 Children's Residential Services
16-218 Intake Cover Letter to Tribes
16-213 Verification of Legal Status
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
16-202A Corrective Action Plan (Developmental Disabilities Administration)
16-202 5-Day Investigation Report (Developmental Disabilities Administration (DDA)
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
16-197 Assisted Living Facility Policies and Procedures Attestation