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(asc) | File Format | |
---|---|---|---|
02-566 | Protected Health Information (PHI) Amendment | ||
15-344 | Private Duty Nursing Logs and Skilled Nursing Tasks Log | ||
02-740 | Private Duty Nursing (PDN) Time Log for the Month of (Home and Community Services) | ||
05-273 | Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services) | ||
10-650 | Private Duty Nursing (PDN) Contract Monitoring Tool (Home and Community Services) | ||
15-594 | Private Duty Nursing (PDN) Care Plan (Aging and Long-Term Services Administration) | ||
27-115 | Privacy Complaint | ||
17-208A | PRISM Access Request for Multiple Organizations | ||
13-783 | Pressure Injury Assessment and Documentation (Home and Community Services) | ||
17-284 | Preferred Sign Language Interpreter List (Office of Deaf and Hard of Hearing) | ||
10-268 | Pre-Placement Agreement (Developmental Disabilities Administration) | ||
11-106 | Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation) | ||
11-112 | Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation) | ||
11-110 | Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation) | ||
17-229 | Pre-Admission Screening and Resident Review (PASRR) Records Request | ||
17-321 | Pre-Admission Screening and Resident Review (PASRR) Equipment Purchase Request | ||
14-538 | Pre-Admission Screening and Resident Review (PASRR) Addendum | ||
15-382 | Positive Behavior Support Plan (PBSP) | ||
10-572 | Planned Respite Application (Developmental Disabilities Administration) | ||
10-648 | Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
10-573 | Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination | ||
13-021 | Physical Evaluation | ||
16-235 | Photo Release | ||
00-399 | Phase 2 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
00-398 | Phase 1 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) |