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.

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Number(desc) Form Name File Format
15-318 Crisis Diversion Bed Referral and Intake Information (Developmental Disabilities Administration)
15-342 Notice of Exception to Rule Decision
15-360 Residential Services Vacancy Profile (Developmental Disabilities Administration)
15-384 Provider Progress Report of Behavior Management and Consultation and Staff/Family Training and Consultation Services (DDA)
15-419 Refusal of Services Statement
15-424 Staffed Residential Cost of Care Adjustment Request
15-435 Documentation of Early Support for Infants and Toddlers (ESIT) for Developmental Disabilities Administration
15-449 Adult Family Home Disclosure of Charges Required by RCW 70.128.280
15-458 Adult Family Home Notice of Transfer or Change
15-494 Residential Habilitation Center (RHC) / Individual Habilitation Plan (IHP) / Individual Plan of Care (IPOC) Meeting Notification (Developmental Disabilities Administration)
15-569 Notice of Termination of Service (Developmental Disabilities Administration)
15-599 Early Engagement of Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
15-601 New Freedom (NF) Notice of Exception to Rule (ETR) Decision (Goods and Services)
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
16-172 Your Rights and Responsibilities When You Receive Services Offered by Aging and Disability Services Administration and Developmental Disabilities Administration
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
16-213 Verification of Legal Status
16-234 Vulnerable Adult Statement of Rights (Intended for use in NH, ALF, AFH, ICF/IID (non RHC) and ESF)
16-234A Vulnerable Adult Statement of Rights (Intended for use in CCRSS and ICF/IID (RHC))
16-235 Photo Release
16-243 Community Services Office (CSO) Compliments and Concerns (Economic Services Administration)
16-246 Your rights as a client of the Developmental Disabilities Administration
16-247 Your Rights and Responsibilities When You Receive MAC or TSOA Services Offered by ALTSA
16-253 For Field Staff Use: Sex Offender Notification to Home Care Agency and Consumer Directed Employer (Home and Community Services)