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 Form Name(desc) File Format
15-318 DDA Crisis Diversion Bed Referral and Intake Information
16-237 DDA GovDelivery Communication Request (Developmental Disabilities Administration)
10-331 DDA Mortality Review Provider Report (Developmental Disabilities Administration)
13-911 DDA Nursing Service Referral (Developmental Disabilities Administration)
10-583 DDA PASRR Cover Sheet
10-623 DDA PASRR Significant Change Invalidation (Developmental Disabilities Administration) (Pre-Admission Screening and Resident Review)
13-903 DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration)
10-688 DDA Specialty Adult Family Home (AFH) Pilot Monthly Client Goal and Progress Report (Developmental Disabilities Administration)
10-687 DDA Specialty Adult Family Home (AFH) Pilot: Strengths, Abilities, Interests, Learn (SAIL) (Developmental Disabilities Administration)
15-597 DDA Youth Transitional Care Facility Admission Checklist (Developmental Disabilities Administration)
11-134 Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation)
27-219 Death Notification Checklist for Medical Providers (Developmental Disabilities Administration)
27-218 Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration)
09-693 Declaration of Lawful Custody
18-433 Declaration of Support Payments (Division of Child Support)
27-155 Declaration on Commercial Purposes
27-208 Declaration to Adult Protective Services
18-398B Department of Children, Youth, and Families (DCYF) Client Overpayment Notice
18-682 Detail Sheet – Uninsured Health Care Expenses
18-700 Direct Deposit Authorization
14-432 Direct Deposit Enrollment
14-332 Disability Assessment
14-530 Disability Review
10-351 Disclosure of Services Required by RCW 18.20.300
11-180 Discovery Profile Report (Division of Vocational Rehabilitation)