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 | |
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14-552 | TED Program Pilot Project: Application for Emergency Alerting Device KIT (Office of the Deaf and Hard of Hearing) | ||
14-427 | Teen Parent Living Assessment | ||
27-215 | Teleservice Agreement (Developmental Disabilities Administration) | ||
02-586 | Temporary Employment Hours Tracking Log | ||
10-437 | Temporary Manager and/or Receiver Application Nursing Home and Assisted Living Facility | ||
13-906 | Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services) | ||
17-345 | Transitional Care Management Exchange of Information (Developmental Disability Administration) | ||
10-574A | Transitional Care Planning Tracking: Part A. Transition Preparation (Developmental Disabilities Administration) | ||
10-574B | Transitional Care Planning Tracking: Part B. Active Coordinator of Transition (ACT) (Developmental Disabilities Administration) | ||
10-574C | Transitional Care Planning Tracking: Part C. Post Move and Stabilization (Developmental Disabilities Administration) | ||
01-210 | Transmittal of Client Funds from the Protective Payee | ||
18-544 | Transmittal of Resident Personal Funds | ||
11-058 | Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation) | ||
10-628 | Trust Fund Review (Aging and Long-Term Support Administration) | ||
14-449 | Unmet Need Breakdown | ||
18-398A | Vendor / Provider Overpayment Notice |
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09-013 | Vendor Affidavit of Lost, Stolen, or Destroyed Warrant | ||
17-299 | Vendor Agreement Information (Behavioral Health Administration) | ||
16-213 | Verification of Legal Status | ||
11-098 | Vocational Assessment Worksheet |
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10-424 | Voluntary Participation Statement (Developmental Disability Administration) |
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09-004C | Voluntary Placement Agreement for Child or Youth with Developmental Disabilities | ||
15-184 | Volunteer Chore Service Referral | ||
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) |