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 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)