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 | |
|---|---|---|---|
| 15-573 | Enhanced Services Facility (ESF) Resident List | ||
| 15-572 | Enhanced Services Facility (ESF) Request for Documentation | ||
| 15-571 | Enhanced Services Facility (ESF) Pre-Inspection Preparation | ||
| 15-569 | Notice of Termination of Service (Developmental Disabilities Administration) | ||
| 15-568 | DDA Alternative Living Provider Orientation (Developmental Disabilities Administration) | ||
| 15-567 | On-the-Job Facility Training Plan Application and Updates (Home and Community Services) | ||
| 15-565 | Nursing Home (NH) Complaint Investigation (CI) Skill Building Tool | ||
| 15-564 | Residential Quarterly Report for Children's Residential Services (Developmental Disabilities Administration) | ||
| 15-560 | Room Requirements Checklist (Home and Community Services) | ||
| 15-559 | Adult Family Home Referral Request (Developmental Disabilities Administration) | ||
| 15-558 | Adult Family Home (AFH) Resident Significant Change Assessment Request | ||
| 15-556 | Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration) | ||
| 15-555 | Facility Training Program Application and Updates (Home and Community Services) | ||
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 15-552 | Curriculum Approval 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) | ||
| 15-515 | CCSS Family Agreement (Community Crisis Stabilization Services) (Developmental Disabilities Administration) | ||
| 15-514 | Companion Home (CH) Client Individual Financial Plan (IFP) (Developmental Disabilities Administration) | ||
| 15-512 | Companion Home and Alternative Living Services Incident Report (Developmental Disabilities Administration) |
