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 | |
|---|---|---|---|
| 14-473 | Inventory for Client and Agency Planning (ICAP) Letter | ||
| 15-365 | Community Protection Treatment Worksheet Quarterly Review | ||
| 15-380 | Individual and Family Services Assessment Worksheet (Developmental Disabilities Administration) | ||
| 15-381 | Respite Assessment Worksheet | ||
| 15-581 | Enhanced Services Facility (ESF) Notes / Worksheets | ||
| 15-582 | Enhanced Services Facility (ESF) Exit Preparation Worksheet | ||
| 15-584 | Enhanced Services Facility (ESF) Medication Pass Worksheet | ||
| 15-585 | Enhanced Services Facility (ESF) Staff Schedule Worksheet (Residential Care Services) | ||
| 15-585A | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 8-hour Shift (Residential Care Services) | ||
| 15-585B | Enhanced Services Facility (ESF) Staff Schedule Worksheet: 12-hour Shift (Residential Care Services) | ||
| 15-589B | Adult Family Home (AFH) Licensing: Resident Bedroom / Bathroom Worksheet Continuation (Residential Care Services) | ||
| 16-205 | Personal Emergency Plan Information (Developmental Disabilities Administration (DDA)) | ||
| 16-288 | Pre-Occupancy Worksheet: Resident Room / Bathroom (Residential Care Services) | ||
| 17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
| 17-180 | Personal Information Release (Economic Services Administration) | ||
| 17-257 | Companion Home Client Budget Worksheet (Developmental Disabilities Administration) | ||
| 17-259 | Companion Home Client Inventory Record | ||
| 17-300 | BHA Personal Information Release (Behavioral Health Administration) | ||
| 17-337 | Personal Service Request / Standard Referral (Behavioral Health Administration) | ||
| 17-337 | Personal Service Request / Standard Referral (Developmental Disabilities Administration) | ||
| 18-544 | Transmittal of Resident Personal Funds | ||
| 18-555 | Financial Information Sheet | ||
| 18-682 | Detail Sheet – Uninsured Health Care Expenses | ||
| 27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult |
