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 | |
|---|---|---|---|
| 27-175 | DVR Additional Contractor Information (Division of Vocational Rehabilitation) | ||
| 27-176 | Release of Liability (Developmental Disabilities Administration) | ||
| 27-179 | Adult Family Home (AFH) Informal Dispute Resolution (IDR) Request (Residential Care Services) | ||
| 27-182 | DSHS Request for Positive Identification – Thumbprint | ||
| 27-188 | Initial Opiate Prescription Informed Consent (Behavioral Health Administration) | ||
| 27-189 | Asset Verification Authorization (Home and Community Services) | ||
| 27-207 | Acknowledgement Statement (Meaningful Day) (Home and Community Services) | ||
| 27-209 | Nursing Home Informal Dispute Resolution Request (Residential Care Services) | ||
| 27-210 | DDA Authorization for Release of Referral Video (Developmental Disabilities Administration) | ||
| 27-218 | Death Notification Checklist for Residential Habilitation Center (RHC) Staff (Developmental Disabilities Administration) | ||
| 27-219 | Death Notification Checklist for Medical Providers (Developmental Disabilities Administration) | ||
| 27-220 | Disposition of Remains / Release of Body Permit (Developmental Disabilities Administration) | ||
| 27-221 | DSHS Claim of Stolen EBT Benefits |
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| 27-222 | Consent to Release and/or Use Confidential Information for Completing an Adult Home License Application | ||
| 27-226 | Adult Family Home Management Agreement: Attestation Information and Attachments (Residential Care Services) | ||
| 27-228 | CCLS Additional Delegated Authority Request | ||
| 27-234 | CCLS Small Business Self-Certification Statement | ||
| 27-240 | Medicaid Provider Disclosure Statement for Nursing Facility | ||
| 27-245 | Central Contracts and Legal Services (CCLS) Vendor Agreement Review | ||
| 27-247 | Residential Habilitation for Dependent Agreement for Youth (Age 18-20) (Developmental Disabilities Administration) | ||
| 27-248 | Residential Habilitation for Dependent Youth Acknowledgement (Developmental Disabilities Administration) |
