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
13-712 Behavioral Health Wraparound Support (BHWS) Request (Home and Community Services Administration)
13-713 Fast Track Service Agreement
13-776 HCS / AAA Nursing Services Referral (Home and Community Services)
13-780 Nursing Services Basic Skin Assessment (Home and Community Services)
13-783 Pressure Injury Assessment and Documentation (Home and Community Services)
13-784 Nursing Services Assessment
13-865 Psychological / Psychiatric Evaluation
13-893 Nurse Delegation: Request For Additional Units
13-899 Review of Medical Evidence
13-906 Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services)