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
27-059 Fingerprint Appointment
27-063 Out-of-Home Services Agreement for Youth (Age 18-21) (Developmental Disabilities Administration)
27-076 Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult
27-089 Fingerprint-Based Background Check Notice
27-094 Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration)
27-096 Permission to Share Documents for Reimbursement of Health Care Expenses
27-109 BCCU Applicant Affidavit
27-110 Applicant Request for a Copy of Background Check Information
27-115 Privacy Complaint
27-123 Provider Owned Housing Memorandum of Understanding Renter Attestation