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
03-374E Nondisclosure of Confidential Information Agreement for Non-Employee (eJAS Access)
27-156 Notice and Consent of Communication via Text or Unencrypted Email
14-515 Notice and Finding of Responsibility
05-246 Notice of Action Exception to Rule (Excluding AFH)
05-256 Notice of Action Exception to Rule for AFH Daily Rates
15-342 Notice of Exception to Rule Decision
14-460 Notice of Insufficient Information (Developmental Disabilities Administration)
14-535 Notice of Insufficient Information for Reapplication (Developmental Disabilities Administration)
06-189 Notice of Suspension of Supported Living Services (Developmental Disabilities Administration)
15-569 Notice of Termination of Service (Developmental Disabilities Administration)
14-402 Notice to Parents (WorkFirst)
14-401 Notification of Address Disclosure Request - Part 1
14-401A Notification of Address Disclosure Request - Part 2
10-377 Notification of Age Four (4) Enrollment Expiration-
15-290 Notification of Annual Assessment Review and Person Centered Services Planning Meeting
10-301 Notification of Enrollment Review (Developmental Disabilities Administration)
14-491 NSA Representative Checklist forDDA Review
16-193 Nurse Aide Registry Inquiry (ADSA)
01-212 Nurse Delegation Referral and Communication
16-273 Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration)
13-678 Page 1 Nurse Delegation: Consent for Delegation Process
13-678 Page 2 Nurse Delegation: Instructions for Nursing Task
13-678B Nurse Delegation: Assumption of Delegation
13-681 Nurse Delegation: Change in Medical Orders
10-217 Nurse Delegation: Nursing Assistant Credentials and Training