Electronic DSHS Forms
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(desc) | Form Name | File Format | |
|---|---|---|---|
| 13-917 | Intensive Habilitation Services (IHS) Medical / Dental Services Authorization (Developmental Disabilities Administration) | ||
| 13-919 | Weekly Status Update (Competency Restoration Program) (Behavioral Rehabilitation Administration) | ||
| 13-920 | Outpatient Competency Restoration Program (OCRP) Discharge Summary | ||
| 13-925 | Request for Formulary Admission or Deletion (Behavioral Health Administration) | ||
| 13-925A | Non-Formulary Drug Use Request (Behavioral Health Administration) | ||
| 13-926 | Forensic (6358) Consultation (Behavioral Health Administration) | ||
| 13-927 | Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration) | ||
| 13-928 | Withdrawal of Petition for Conditional Release or Unconditional Release (Behavioral Health Administration) | ||
| 13-935 | State Hospital Triage Consultation and Expedited Admission (TCEA) Request | ||
| 13-939 | Residential Care Services (Adult Family Home, Assisted Living Facility, Enhanced Services Facility) Community Programs Infection Prevention and Control (ICP) InspectionTool | ||
| 13-940 | RCS (AFH, ALF, ESF) Community Programs Infection Prevention and Control (IPC) Complaint Investigation Pathway (Residential Care Services) | ||
| 13-941 | RCS (AFH, ALF, ESF) Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services) | ||
| 13-942 | CCRSS Infection Prevention and Control (IPC) Complaint Investigation Tool (Residential Care Services) | ||
| 13-943 | Certified Community Residential Supports and Services (CCRSS) Infection Prevention and Control (IPC) Complaint Investigation Pathway | ||
| 13-944 | RCS (AFH, ALF, and ESF) Infection Prevention and Control (IPC) Assessment Notes (Residential Care Services) (Adult Family Home, Assisted Living Facility, and Enhanced Services Facility) | ||
| 13-945 | RCS Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Notes (Residential Care Services) | ||
| 13-951 | Aspiration / Choking Plan (Developmental Disabilities Administration) | ||
| 13-952 | Bowel Protocol (Developmental Disabilities Administration) | ||
| 13-953 | Medication Administration Record (MAR) (Developmental Disabilities Administration) | ||
| 13-954 | Seizure Protocol (Developmental Disabilities Administration) | ||
| 13-955 | Vital Signs Tracking (Developmental Disabilities Administration) | ||
| 13-956 | Skin Observation (Developmental Disabilities Administration) | ||
| 14-001 | Application for Cash or Food Assistance |
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| 14-012 | Consent |
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| 14-050 | Statement of Health, Education, and Employment |
