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 | Form Name(desc) | File Format | |
|---|---|---|---|
| 10-629 | Pet Record Review (Aging and Long-Term Support Administration) | ||
| 09-280B | Petition for Modification - Administrative Order |
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| 00-398 | Phase 1 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
| 00-399 | Phase 2 Higher Education and Workforce Training COVID-19 Requirements (Home and Community Services) | ||
| 16-235 | Photo Release | ||
| 13-021 | Physical Evaluation | ||
| 10-573 | Planned Action Notice - Pre-Admission Screening and Resident Review (PASRR) Determination | ||
| 10-648 | Planned Action Notice PASRR Determination Supporting Information (Pre-Admission Screening and Resident Review) (Developmental Disabilities Administration) | ||
| 10-572 | Planned Respite Application (Developmental Disabilities Administration) | ||
| 15-382 | Positive Behavior Support Plan (PBSP) | ||
| 14-538 | Pre-Admission Screening and Resident Review (PASRR) Addendum | ||
| 17-321 | Pre-Admission Screening and Resident Review (PASRR) Equipment Purchase Request | ||
| 17-229 | Pre-Admission Screening and Resident Review (PASRR) Records Request | ||
| 11-110 | Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation) | ||
| 11-112 | Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation) | ||
| 11-106 | Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation) | ||
| 10-268 | Pre-Placement Agreement (Developmental Disabilities Administration) | ||
| 17-284 | Preferred Sign Language Interpreter List (Office of Deaf and Hard of Hearing) | ||
| 13-783 | Pressure Injury Assessment and Documentation (Home and Community Services) | ||
| 17-208A | PRISM Access Request for Multiple Organizations | ||
| 27-115 | Privacy Complaint | ||
| 15-594 | Private Duty Nursing (PDN) Care Plan (Aging and Long-Term Services Administration) | ||
| 10-650 | Private Duty Nursing (PDN) Contract Monitoring Tool (Home and Community Services) | ||
| 05-273 | Private Duty Nursing (PDN) Pre-Contract Education Attestation (Home and Community Services) | ||
| 02-740 | Private Duty Nursing (PDN) Time Log for the Month of (Home and Community Services) |
