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
04-452 DSHS Community Services Survey (Community Services Division, Economic Services Administration)
04-452A DSHS Community Services Customer Survey (Community Services Division)
05-010 Rule Exception Request
05-013 Request for Hearing
05-248 On-Site Review (Office of Refugee and Immigrant Assistance)
05-249 Notice of Bed Hold (Residential Care Services)
05-252 Code of Ethics and Standards of Practice (Division of Vocational Rehabilitation)
05-255 Medicaid Transformation Project Notice of Action Exception to Rule
05-258 Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment
05-259 Risk, Needs, and Responsivity for Assessments and Treatment Planning (Domestic Violence Intervention Treatment)