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 | Form Name(desc) | File Format | |
|---|---|---|---|
| 05-249 | Notice of Bed Hold (Residential Care Services) | ||
| 15-342 | Notice of Decision (Non-PC) Exception to Rule (Developmental Disabilities Administration) | ||
| 14-460 | Notice of Insufficient Information (Developmental Disabilities Administration) |
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| 14-535 | Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration) | ||
| 06-189 | Notice of Suspension of Supported Living Services (Developmental Disabilities Administration) | ||
| 15-569 | Notice of Termination of Service (Developmental Disabilities Administration) | ||
| 15-458 | Notice of Transfer or Discharge (Residential Care Services) |
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| 14-402 | Notice to Parents (WorkFirst) |
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| 14-401 | Notification of Address Disclosure Request - Part 1 | ||
| 14-401A | Notification of Address Disclosure Request - Part 2 | ||
| 10-377 | Notification of Age Four (4) Enrollment Expiration- |
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| 15-290 | Notification of Annual Assessment Review and Person Centered Services Planning Meeting | ||
| 10-301 | Notification of Enrollment Review (Developmental Disabilities Administration) |
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| 14-491 | NSA Representative Checklist forDDA Review | ||
| 16-193 | Nurse Aide Registry Inquiry (Home and Community Living Administration) | ||
| 13-960 | Nurse Case Review Referral (Home and Community Services) | ||
| 01-212 | Nurse Delegation Referral and Communication | ||
| 16-273 | Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration) | ||
| 13-678 Page 1 | Nurse Delegation: Consent for Delegation Process | ||
| 13-678 Page 2 | Nurse Delegation: Instructions for Nursing Task | ||
| 13-678B | Nurse Delegation: Assumption of Delegation | ||
| 13-681 | Nurse Delegation: Change in Medical Orders | ||
| 10-217 | Nurse Delegation: Nursing Assistant Credentials and Training | ||
| 14-484 | Nurse Delegation: Nursing Visit | ||
| 13-678A | Nurse Delegation: PRN Medication |
