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
16-182 Guidelines for Completing the ICAP / SIB-R Adaptive Behavior Scale (Developmental Disabilities Administration)
16-191 SOLA Vehicle Trip Log (Developmental Disabilities Administration)
16-193 Nurse Aide Registry Inquiry (Home and Community Living Administration)
16-195 Information About Your Role as the Identified Necessary Supplemental Accommodation (NSA) Representative
16-197 Assisted Living Facility Policies and Procedures Attestation
16-201 New Case / Resource Manager Assessment (Developmental Disabilities Administration)
16-202 Investigation Report (Developmental Disabilities Administration)
16-202A Corrective Action Plan (Developmental Disabilities Administration)
16-205 Personal Emergency Plan Information (Developmental Disabilities Administration (DDA))
16-213 Verification of Legal Status