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
16-269 Adult Family Home No One Home Letter (Residential Care Services)
16-270 Adult Family Home Agrees to Postpone Inspection Date Letter (Residential Care Services)
16-273 Nurse Delegation Training for Nursing Assistance and Long Term Care Workers (LTCW) (Developmental Disabilities Administration)
16-275 Change of Circumstance: Community Behavioral Health Supports (CBHS) / 1915i (Home and Community Services)
16-276 Diversion Navigator Interview (Office of Forensic Mental Health Services (OFMHS))
16-277 Adult Family Home (AFH) Confirmation Letter (Residential Care Services)
16-278 Exhibit E: School-to-Work Success Story (Division of Vocational Rehabilitation)
16-279 Your Responsibility for Participation Towards Costs of Care at a Youth Transitional Care Facility (Developmental Disabilities Administration)
16-280 Individual Home and Community Based Settings (HCBS) Checklist for Residential Providers Resources
16-282 Independent Informal Dispute Resolution (IIDR) Request (Residential Care Services)