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
17-208A PRISM Access Request for Multiple Organizations
17-211 Authorization for SSI Facilitation Records (Economic Services Administration)
17-226 AAA Systems Access Request (SAR) for DSHS / HCS / ESD Systems
17-227 DSHS / HCA Systems Access Request
17-229 Pre-Admission Screening and Resident Review (PASRR) Records Request
17-230 Non-Emergency Medical Transportation (NEMT) for PASRR Program Request
17-231 Mental Incapacity Evaluation (MIE) Contractor Travel Plan
17-238 ODHH Approved Sign Language Interpreter Complaints
17-253 DSHS Background Check System (BCS) Access Request
17-257 Companion Home Client Budget Worksheet (Developmental Disabilities Administration)