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
10-556 Resident Record Review (Residential Care Services)
10-557 Resident Medication Review (Residential Care Services)
10-558 Comprehensive Resident / Representative Interview (Residential Care Services)
10-558A Condensed Resident / Representative Interview (Residential Care Services)
10-559 Administrative Records Review (Residential Care Services)
10-559A Administrative Records Review Continuation (Residential Care Services)
10-559B Administrative Records Review - Former Staff and Others with Unsupervised Access (Residential Care Services)
10-560 Provider / Resident Manager Interview (Residential Care Services)
10-561 Staff Interview (Residential Care Services)
10-562 Exit Preparation Worksheet (Residential Care Services)