Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

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 Form File
10-255 Public Health Nurse (PHN) Summary and Recommendations
10-258 Individual With Possible Community Protection Issues (Developmental Disabilities Administration)
10-268 Pre-Placement Agreement (Developmental Disabilities Administration)
10-269 Alternative Living Services Plan and Provider Progress Report (Developmental Disabilities Administration)
10-269A Alternative Living Services Plan and Provider Progress Report Supplement to DSHS form 10-269 (Developmental Disabilities Administration)
10-270 Adult Family Home / Assisted Living Facility / Enhanced Services Facility Admission Agreement(s) Attestation
10-272 Cross-System Crisis Plan (DDA)
10-277 Request for Children's Out-of-Home Services (Developmental Disabilities Administration)
10-301 Notification of Enrollment Review (Developmental Disabilities Administration)
10-326 Staffed Residential Rate Proposal (Developmental Disabilities Administration)