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
14-555 WA Cares Application Attestation
15-031 Nursing Facility Notice of Action
15-184 Volunteer Chore Service Referral
15-215 DDCS AFH Quality Improvement Visit Assessment (Development Disabilities Community Living / Adult Family Home)
15-274 Assistance Available Schedule (DDA)
15-290 Notification of Annual Assessment Review and Person Centered Services Planning Meeting
15-291 Person Centered Service Planning and Annual Assessment Meeting Notice (Developmental Disabilities Community Services)
15-295 Person Centered Service Plan Meeting Survey (Developmental Disabilities Administration)
15-304 HCBS Waiver Enrollment Database Update (Developmental Disabilities Administration)
15-314 Client Necessary Supplemental Accommodation Representative Requirement Checklist