Washington State Department of Social and Health Services Forms

This document is the approval notification for the Home and Community-Based Services (HCBS) Waiver in Washington state. It is specifically for individuals of Cambodian descent.

This document is used for notifying the approval of Home and Community-Based Services (HCBS) waiver under the Developmental Disabilities Administration (DDA) in Washington.

This form is used for providing supporting information for Washington's Planned Action Notice (PASRR) Determination.

This document is a DSHS Form used in Washington State for referring individuals who need supported employment services. It is available in Farsi language.

This form is used for confirming autistic disorder in the State of Washington.

This form is used for renewing the registration of Continuing Care Retirement Communities (CCRC) in Washington state.

This form is used for Employment and Day Program Services Providers in Washington to report cases of abuse, improper use of restraint, neglect, personal or financial exploitation, or abandonment of a child or vulnerable adult.

This form is used for voluntarily placing a child or youth with developmental disabilities in Washington state. It is available in Amharic.

This document is a Voluntary Placement Agreement (VPA) form in Chinese for parents or guardians of a child or youth with developmental disabilities in Washington. It is used to make arrangements for the voluntary placement of the child or youth in a facility or program for their care and well-being.

This document is used for obtaining consent for the nurse delegation process in Washington. It is available in both English and Cambodian languages.

This form is used for documenting the first use of Medicaid benefits in the state of Washington. It is used to record and verify the individual's eligibility and the services received.

This Form is used for verifying child care services in Washington state. It is specifically designed for the Lao community.

This form is used for tracking the class list of community instructors in Washington.

This form is used for reporting the progress of alternative living services plans and providers in Washington state.

This form is used for notifying the Washington Department of Social and Health Services (DSHS) about the expiration of eligibility for children aged four (4) in the Oromo language.

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

This Form is used for conducting client interviews to evaluate eligibility for the Ccrss Certification program in Washington State.

This Form is used for requesting a waiver of the administrative disqualification hearing in the state of Washington.