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.

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Number(desc) Form Name File Format
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
14-012 Consent
14-050 Statement of Health, Education, and Employment
14-057 Child Support Referral
14-057B Noncustodial Parent Child Support Enforcement Application
14-057D Child Support Referral Continuation