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
17-238 ODHH Approved Sign Language Interpreter Complaints
02-740 Office of Justice and Civil Rights Complaint Request
05-248 On-Site Review (Office of Refugee and Immigrant Assistance)
15-567 On-the-Job Facility Training Plan Application and Updates (Home and Community Services)
10-669 Out-of-Home Services (OHS) Transition Checklist (Developmental Disabilities Administrations)
27-063 Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration)
13-920 Outpatient Competency Restoration Program (OCRP) Discharge Summary
20-333 Outpatient Competency Restoration Program (OCRP) Transition Plan (Behavioral Health Administration)
17-294 Outpatient Competency Restoration Program Clinical Screening (Behavioral Health Administration)
10-639 Overnight Planned Respite Services (OPRS) Certification Evaluation (Developmental Disabilities Administration)
10-571 Overnight Planned Respite Services Individualized Agreement
10-630 Paid Feeding Assistant Program Review (Aging and Long-Term Support Administration)
07-103A Participant Reimbursement with Interpreter Declaration
04-449 Participants Feedback (Domestic Violence Intervention Treatment)
07-081 Participation Reimbursement
15-493 PASRR Client Referral
10-668 PASRR Level 2 Evaluation and Determination (Developmental Disabilities Administration)
10-643 PASRR Request for Skilled Nursing in a Community Setting (Pre-admission Screening and Resident Review) (Developmental Disabilities Administration)
27-053 Paternity Information
10-509 Pediatric Symptoms Checklist (PSC-17)
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
15-295 Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration)
15-291 Person Centered Service Planning and Annual Assessment Meeting
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
17-180 Personal Information Release (Economic Services Administration)