Washington State Department of Social and Health Services Forms

This document is used to request documentation for medical or disability conditions in Washington. It is available in Somali language.

This form is used for requesting documentation for medical or disability conditions in Washington. The form is available in Korean language.

This form is used to notify individuals in Washington whose eligibility for services is expiring. It is specifically for individuals who are turning four years old. The form is available in Tagalog language.

This document is a notification form used in Washington to inform individuals about the expiration of eligibility for certain benefits at the age of four.

This document is used for submitting additional room lists for Assisted Living Facilities (ALF) in Washington.

This Form is used for applying for Supplemental Security Income (SSI) benefits in the state of Washington.

This document is used for requesting information from the Department of Social and Health Services (DSHS) in Washington. It is available in Samoan language.

This Form is used for requesting information from the Washington State Department of Social and Health Services (DSHS).

This form is used for requesting information from the Department of Social and Health Services (DSHS) in Washington state. It is specifically translated into Somali.

This type of document is an information request letter in Tagalog used by the Washington Department of Social and Health Services (DSHS).

This document is for requesting information from the Department of Social and Health Services (DSHS) in Washington.

This form is used for reporting abuse, neglect, exploitation, or abandonment of a child or vulnerable adult to the Washington State Department of Social and Health Services (DSHS).

This document is for individuals in Washington who want to voluntarily participate in the Developmental Disability Administration program. It is available in Somali language.

This form is used for the initial visit to an Adult Family Home (AFH) in Washington state for quality improvement purposes.

This document is used for attesting to the caregiver experience in an Adult Family Home in the state of Washington. It is a required form for caregivers in this setting.

This document is used for authorization of child care in Washington state.

This form is used for keeping a medical log in Washington state. It is available in both English and Russian languages.

This form is used for creating a care plan for a child and family team in Washington state.

This type of document is a form used by the Washington State Department of Social and Health Services (DSHS) for the Child and Family Team (CFT) to create a plan of care for a child and their family.

This Form is used for obtaining consent for the Extended Foster Care Program in Washington state in Spanish.

This Form is used for creating a Health Action Plan (HAP) in Washington State. The form provides instructions on how to fill it out and create a plan to address health needs and goals.

This document is a consent agreement for the sharing of confidential health information in Washington. It is available in Somali language.

This type of document is a checklist form used for requesting an extension of limitations in Washington state.

This form is used for creating a Health Action Plan (HAP) in the state of Washington. It helps individuals and their healthcare providers outline specific actions and goals for managing their health conditions.

This document for requesting an extension of limitations under the DSHS in Washington. It is in Russian.

This form is used for explaining the tasks involved in extending limitations for DSHS (Department of Social and Health Services) in Washington. It is available in Somali language.

This form is used to request an extension on certain limitations for clients under the age of 21 in Washington state who are Somali.