Washington State Department of Social and Health Services Forms

This Form is used for creating a Positive Behavior Support Plan (PBSP) in the state of Washington. It helps to develop strategies for managing and promoting positive behavior in individuals with developmental or behavioral challenges.

This Form is used for conducting a Functional Behavioral Assessment (FA) by the Washington State Department of Health and Human Services.

This form is used for residents of Washington State who wish to refuse certain services provided by the Department of Social and Health Services (DSHS).

This form is used for requesting no services paid group under DSHS in Washington state for Cambodian individuals.

This Form is used for the No Paid Services Group in Washington State for individuals who are Lao-speaking.

This Form is used for requesting no paid services for a Russian-speaking individual within the No Paid Services Group in Washington State.

This form is used for applying for the No Paid Services Group in Washington for Somali speakers. It is used by the Department of Social and Health Services to determine eligibility for certain benefits or services.

This Form is used for applying for the No Paid Services Group in Washington state for Vietnamese speakers.

This form is used for a no paid services group in Washington for Korean-speaking individuals through the Department of Social and Health Services (DSHS).

This document is used for notifying clients about termination of services in the Somali language in the state of Washington.

This Form is used for Ukrainian residents in Washington to apply for DSHS services that do not require payment.

This document is a form used by the Washington Department of Social and Health Services (DSHS) for individuals who do not qualify for paid services. It is available in Arabic language.

This Form is used for receiving a denial notice from the Washington State Department of Social and Health Services (DSHS) in Somali language.

This form is used for incomplete applications in Washington for individuals who speak Samoan.

This form is used for the initial application for Certified Community Residential Services and Supports in the state of Washington. It provides instructions for filling out the DSHS Form 15-389.

This Form is used for No Paid Services Group in Washington for individuals speaking Trukese.

This form is used for team coordination in Washington state Assisted Living Facilities. It helps with skill building and fostering collaboration among the staff.

This form is used for documenting skin observation protocols in the state of Washington.

This Form is used for notifying individuals about changes in Medicaid services as part of the Medicaid Transformation Demonstration in Washington State.

This form is used by families and guardians in Washington state to respond to an IHP (Individualized Healthcare Plan) notification from DSHS (Department of Social and Health Services).

This Form is used for making revisions to an Individual and Household Program (IHP) in the state of Washington through the Department of Social and Health Services (DSHS).

This document is a notice for the Medicaid Transformation Demonstration Service in Washington State. It is in Vietnamese language.

This Form is used for reporting community guide and engagement services provided by a provider in Washington State. It is required by the DSHS (Department of Social and Health Services) for program evaluation and monitoring purposes.

This Form is used for creating an Individual Habilitation Plan (IHP) in the state of Washington. It is used to outline the specific goals, needs, and support services for an individual with developmental disabilities.

This document is used for reporting incidents related to companion home and alternative living services in the state of Washington.

This form is used for referring clients to the Washington Department of Social and Health Services (DSHS) for the Purpose of Pre-Admission Screening and Resident Review (PASRR).

This document is used for establishing a Family Agreement as part of the Child Care Subsidy (CCSS) program in Washington State. It outlines the responsibilities and requirements for both the family receiving the subsidy and the Child Care Provider.

This form is used for applying to transition from a group home to a group training home in the state of Washington.