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
17-284 Preferred Sign Language Interpreter List (Office of Deaf and Hard of Hearing)
17-295 Certification Evaluation Checklist for Companion Homes Providers (Home and Community Living Administration)
17-296 Certification Evaluation Checklist for Alternative Living Providers (Developmental Disabilities Administration)
17-297 Removal and Transport Directive (Behavioral Health Administration)
17-299 Vendor Agreement Information (Behavioral Health Administration)
17-300 BHA Personal Information Release (Behavioral Health Administration)
17-301 Medical Expense Examples (Community Services Division, Economic Services Administration)
17-305 DPI Authorization for Release of Information (Division of Program Integrity)
17-333 Assisted Living Facility / Enhanced Services Facility / Adult Family Home Request for Records (Residential Care Services)
17-337 Personal Service Request / Standard Referral (Developmental Disabilities Administration)