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(asc) | File Format | |
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15-492 | Medicaid Transformation Project Service Notice | ||
05-255 | Medicaid Transformation Project Notice of Action Exception to Rule | ||
12-210 | Medicaid Provider Fraud Report | ||
27-240 | Medicaid Provider Disclosure Statement for Nursing Facility | ||
27-094 | Medicaid Provider Disclosure Statement (Aging and Long-Term Support Administration) | ||
10-636 | Meaningful Day Monthly Calendar | ||
10-672 | Meaningful Day Eligibility Checklist (Home and Community Services) | ||
10-637 | Meaningful Activity Plan (MAP) Discovery | ||
27-076 | Mandatory Reporting of Abuse, Neglect, Personal and Financial Exploitation, or Abandonment of a Child or Vulnerable Adult | ||
10-438 | Long-Term Care Partnership (LTCP) Asset Designation | ||
19-074 | Loan Agreement for Tools, Equipment, Initial Stock and Supplies, and Devices (Division of Vocational Rehabilitation) |
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10-505 | Limitation Extension Task Explanation | ||
10-504 | Limitation Extension Request for Clients Under Age 21 | ||
10-506 | Limitation Extension Request Checklist | ||
10-503 | Limitation Extension Evaluation | ||
10-627 | Liability Insurance Review (Aging and Long-Term Support Administration) | ||
14-300 | Level One Pre-Admission Screening and Resident Review (PASRR) | ||
05-258 | Level 4 Questionnaire for Supervisors Applying to Facilitate Level 4 Domestic Violence Intervention Treatment | ||
11-133 | Jobs and Training Inventory (Division of Vocational Rehabilitation) | ||
14-550 | Job Foundation Application (Developmental Disabilities Administration) | ||
13-927 | Involuntary Antipsychotic Medication Hearing Checklist (Behavioral Health Administration) | ||
14-473 | Inventory for Client and Agency Planning (ICAP) Letter | ||
18-464 | Introduction to New Hire Reporting | ||
14-105 | Interview Appointment for Applicant (Community Services Division) |
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11-167 | Internship: Employer Evaluation |