Washington State Department of Social and Health Services Forms

This document provides information about your rights and responsibilities regarding cash and food assistance in Washington. It specifically focuses on providing this information in the Dinka language.

This document is used for acknowledging services provided by the Washington State Department of Social and Health Services (DSHS) in Pangasinan language.

This Form is used for providing notice about a petition to change your address in the state of Washington.

This document is used for authorizing medical and dental services in Washington. It is specifically available in Korean language.

This form is used for enrolling in direct deposit for cash assistance in Washington state. It is available in Russian language.

This form is used for enrolling in cash assistance direct deposit in Washington state. It is available in Korean language.

This Form is used for disability review in Washington State. It is available in Tigrinya language.

This form is used for disability review in Washington state. It is available in Korean language.

This form is used for disclosing charges for adult family homes as required by the Washington state law RCW 70.128.280.

This type of document is for requesting the purchase of equipment for pre-admission screening and resident review in the state of Washington.

This form is used for submitting a school statement for Mien students in Washington State.

This form is used for reporting uninsured health care expenses in Washington for individuals of Cambodian heritage.

This document is a Washington state form for conducting emergency evacuation drills in adult family homes (AFH).

This document is a form for individual healthcare providers in Washington to request personal protective equipment (PPE).

This form is used for adult family homes in Washington to request PPE (personal protective equipment) orders.

This Form is used for withdrawing an administrative hearing in Washington state.

This form is used for providing notice of privacy practices for client medical information in Washington State. It is specifically designed for Persian-speaking individuals.

This Form is used for providing clients with information about the privacy practices related to their medical information for DSHS HIPAA Covered Programs in Washington specifically for Cambodian individuals.

This form is used for requesting a hearing in Washington state. It is available in Persian language.

This document is a petition form used in Washington State to request a modification of an administrative order, written in Persian.