Washington State Department of Social and Health Services Forms

This Form is used for requesting an extension of limitation for clients under 21 years old in Washington.

This Form is used for applying for a medical exemption for the influenza vaccine in Washington state. (Spanish)

This Form is used for collecting feedback and comments from families in Washington state. It is available in Spanish and is called the DSHS Formulario 10-545 Cuestionario De Comentarios Para La Familia.

This Form is used for revisiting attachments in the DSHS (Department of Social and Health Services) Form 10-557 in Washington state.

This form is used for creating an agreement for overnight planned respite services in Washington state.

This form is used for submitting a data summary report and recommendations to the Department of Social and Health Services (DSHS) in Washington state. It is used to provide an overview of data findings and suggested actions.

This form is used for a comprehensive assessment of physical therapy in the state of Washington. It helps evaluate the functional abilities of individuals and determine the appropriate physical therapy interventions needed.

This Form is used for pre-admission screening and resident review (PASRR) determination in the state of Washington.

This Form is used for notifying the eligibility review for individuals with developmental disabilities who are 19 years old in Washington. (Spanish)

This form is used for evaluating restraints or support needed for individuals in Washington state.

This Form is used for conducting a comprehensive functional assessment of communication in the state of Washington.

This form is used to continue the evaluation of restraints and supports in Washington state.

This Form is used for providing information to become a Child Care Subsidy Provider in Washington's Child Care Subsidy Programs.

This Form is used for providing information about the CCSP Provider in Washington state. (Spanish version)

This Form is used for providing information about child care providers in Washington's Child Care Subsidy Program (CCSP) for Somali language users.

This type of document, DSHS Form 10-608 Ccsp Provider Information (Child Care Subsidy Program) - Washington (Tagalog), is used to gather information from Child Care Subsidy Program providers in Washington who speak Tagalog. It helps the state government ensure that the providers meet the necessary requirements to participate in the program.

This form is used for referring adults in Washington to the Adult Day Service program offered by the Department of Social and Health Services (DSHS).

This form is used for pre-certification evaluation preparation for Certified Community Residential Services and Supports (CCRSS) in the state of Washington.

This form is used for conducting interviews and evaluations with family members, representatives, and collateral contacts as part of the certification process for Certified Community Residential Services and Supports (CCRSS) in the state of Washington.

This document is an attachment for DSHS Form 10-621 and contains notes for Certified Community Residential Services and Supports (CCRSS) in Washington state.

This document is used for notifying the Washington State Department of Social and Health Services about a significant change in a person's eligibility for long-term care services.

This document is an attachment to the DSHS Form 10-620 and is used for the review and completion of the Iss Hours Review/Questionnaire for Certified Community Residential Services and Supports in Washington.

This Form is used for the certification evaluation staff interview process for Certified Community Residential Services and Supports (CCRSS) in the state of Washington.

This document is used for completing the Home Environment and Safety Worksheet for Certified Community Residential Services and Supports (CCRSS) in Washington. It assesses the safety and suitability of a home for individuals receiving these services.

This document is used for conducting background checks for Certified Community Residential Services and Supports (CCRSS) in Washington.

This document is a certification evaluation form used for client interviews in Washington for Certified Community Residential Services and Supports (CCRSS).

This Form is used for providing vocational information in Chinese for residents of Washington state. It is a document required by the Department of Social and Health Services (DSHS).