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 | |
|---|---|---|---|
| 15-586 | Enhanced Services Facility (ESF) Inspection Packet | ||
| 15-584 | Enhanced Services Facility (ESF) Medication Pass Worksheet | ||
| 15-602 | Enhanced Services Facility (ESF) Monitoring Visit (Residential Care Services) | ||
| 15-581 | Enhanced Services Facility (ESF) Notes / Worksheets | ||
| 15-576 | Enhanced Services Facility (ESF) Other Contact Interview | ||
| 15-571 | Enhanced Services Facility (ESF) Pre-Inspection Preparation | ||
| 15-572 | Enhanced Services Facility (ESF) Request for Documentation | ||
| 15-574 | Enhanced Services Facility (ESF) Resident Characteristic Roster and Sample Selection | ||
| 15-575 | Enhanced Services Facility (ESF) Resident Interview | ||
| 15-573 | Enhanced Services Facility (ESF) Resident List | ||
| 15-578 | Enhanced Services Facility (ESF) Resident Record Review | ||
| 15-579 | Enhanced Services Facility (ESF) Staff and Administrative Record Review | ||
| 15-585 | Enhanced Services Facility (ESF) Staff Schedule Worksheet (Residential Care Services) | ||
| 15-585B | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 12-hour Shift (Residential Care Services) | ||
| 15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
| 10-535 | Enhanced Services Facility Application | ||
| 10-602 | Enhanced Services Facility Information Changes | ||
| 10-550 | Entrance Information and Observation (Residential Care Services) | ||
| 10-553 | Environmental Tour (Residential Care Services) | ||
| 10-554 | Environmental Tour - Bedrooms (Residential Care Services) | ||
| 14-462 | Epilepsy Verification Request (Developmental Disabilities Administration) | ||
| 10-662 | Equine Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration) | ||
| 03-374D | ESA Non-Dislcosure of Confidential Information Agreement - Non Employee | ||
| 14-454 | Estate Recovery: Repaying the State for Medical and Long Term Services and Supports |
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| 07-107 | Exception to Rule and Notice Guardianship Fees and Related Costs (Aging and Long-Term Support Administration and Developmental Disabilities Administration) |
