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.

Choose search option and begin typing the form #
Keyword Search
Number Form Name(desc) File Format
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
15-398 Medically Intensive Children's Program (MICP) Application
13-953 Medication Administration Record (MAR) (Developmental Disabilities Administration)
10-634 Medication Assistant Endorsement (Aging and Long-Term Support Administration)
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
14-467 Mid-Certification Review
10-334 Monitoring of Side Effects Scale (MOSES) (DDA)
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
10-661 Music Therapy 90-Day (Quarterly) Report (Developmental Disabilities Administration)
02-531 Native Language Identifier
14-495 Naturalization Letter
10-382 Naturalization Services Pre-Screening
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
27-043 New Contractor Intake
15-601 New Freedom (NF) Notice of Exception to Rule (ETR) Decision (Goods and Services)
27-253 New Freedom Authorized Representative (Home and Community Services)
16-244 New Freedom Participant Responsibility Agreement
18-463 New Hire Reporting Methods and Instructions (Division of Child Support)
10-664 New or Update Provider Information Worksheet (Developmental Disabilities Administration)
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
13-925A Non-Formulary Drug Use Request (Behavioral Health Administration)
14-440 Non-Profit Organization Application for Reconditioned Telecommunications Equipment (Office of the Deaf and Hard of Hearing)
18-399A Non-SSPS Client / Provider Overpayment AFRS Coding Computation
16-072 NonAssistance Support Enforcement Information (Division of Child Support)
14-057B Noncustodial Parent Child Support Enforcement Application