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 | |
|---|---|---|---|
| 02-516 | Adult Family Home Resident Personal Belongings Inventory (Residential Care Services) | ||
| 02-586 | Temporary Employment Hours Tracking Log | ||
| 02-692 | Community Instructor Class List Tracking Log | ||
| 02-740 | Private Duty Nursing (PDN) Time Log for the Month of (Home and Community Services) | ||
| 02-756 | High School Home Care Aide Class List Tracking Log (Home and Community Services) | ||
| 10-638 | AFH Meaningful Day - Monthly Activities and Challenging Behavior Log | ||
| 11-066 | Assistive Communication Technology Request (Office of Deaf and Hard of Hearing) | ||
| 11-070 | DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation) | ||
| 11-133 | Jobs and Training Inventory (Division of Vocational Rehabilitation) | ||
| 13-645 | Adult Family Home Injuries and Accidents Log | ||
| 13-865 | Psychological / Psychiatric Evaluation | ||
| 14-473 | Inventory for Client and Agency Planning (ICAP) Letter | ||
| 15-344 | Private Duty Nursing Logs and Skilled Nursing Tasks Log | ||
| 16-191 | SOLA Vehicle Trip Log (Developmental Disabilities Administration) | ||
| 17-116 | AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion | ||
| 17-259 | Companion Home Client Inventory Record | ||
| 17-261 | Assistive Communication Technology (ACT) Contractor Assignment Report (Office of Deaf and Hard of Hearing) | ||
| 17-292 | Assistive Communication Technology (ACT) Program Service Request / Work Order for Induction Loops (Office of the Deaf and Hard of Hearing) |
