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
10-695 Adult Family Home (AFH) Initial Inspection Preparation Checklist (Residential Care Services)
10-696 Assisted Living Facility Medication Observation Worksheet (Home and Community Living Administration)
10-698 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Administrator Record Review and Interview (Residential Care Services)
10-699 Certified Community Residential Services and Supports (CCRSS) Certification Evaluation Exit Preparation / Exit Conference (Residential Care Services)
10-700 CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.)
10-701 Enhanced Respite Services School Notification (Developmental Disabilities Administration)
10-703 Enhanced Services Facility (ESF) Staff Interview (Residential Care Services)
10-705 Lake Burien Transitional Facility Specialized Treatment Referral and Application (Developmental Disabilities Community Services)
10-706 Lake Burien Transitional Care Facility Dedicated Review Committee (DRC) Determination (Developmental Disabilities Administration)
10-707 Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration)