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
02-756 High School Home Care Aide Class List Tracking Log (Home and Community Services)
02-758 Subleased Housing Memorandum of Understanding Renter Attestation (Developmental Disabilities Administration)
02-759 Subleased Housing Memorandum of Understanding Residential Provider Attestation (Developmental Disabilities Administration)
02-760 Case Mix Index Detail (CMID) Report Authorization (Home and Community Living Administration (HCLA))
02-766 Care Agreement for Beneficiaries and their Caregivers (WA Cares)
03-076 Employee Personal Property Damage/Loss Claim
03-077 Release of All Claims
03-374B Agreement on Nondisclosure of Confidential Information - Non-Employee
03-374D ESA Non-Dislcosure of Confidential Information Agreement - Non Employee
03-374E Nondisclosure of Confidential Information Agreement for Non-Employee (eJAS Access)