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 | |
|---|---|---|---|
| 13-712 | Behavioral Health Wraparound Support (BHWS) Request (Aging and Long-Term Support Administration (ALTSA) | ||
| 13-713 | Fast Track Service Agreement |
|
|
| 13-738 | DDA / DCYF Request to Cost Share (Developmental Disabilities Administration) (Department of Children, Youth, and Families) | ||
| 13-776 | HCS / AAA Nursing Services Referral (Home and Community Services) | ||
| 13-780 | Nursing Services Basic Skin Assessment (Home and Community Services) | ||
| 13-783 | Pressure Injury Assessment and Documentation (Home and Community Services) | ||
| 13-784 | Nursing Services Assessment | ||
| 13-851 | Psychiatric Referral Summary | ||
| 13-865 | Psychological / Psychiatric Evaluation | ||
| 13-893 | Nurse Delegation: Request For Additional Units | ||
| 13-899 | Review of Medical Evidence | ||
| 13-903 | DDA Request for Additional Units Nurse Delegation (Developmental Disability Administration) | ||
| 13-906 | Therapy Evaluation for Bed Transfer / Positioning Devices (Typically Bed or Side Rails) (Home and Community Services) | ||
| 13-911 | DDA Nursing Service Referral (Developmental Disabilities Administration) | ||
| 13-915 | Information for Respite Care Service Providers: Addendum to TCARE Assessment (Aging and Long-Term Support Administration) | ||
| 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 |
