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2309
![DSHS Form 10-577 Attachment R "Revisits" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238184/dshs-form-10-577-attachment-r-revisits-washington.png "DSHS Form 10-577 Attachment R "Revisits" - Washington")
![DSHS Form 10-369 Attachment K "Assisted Living Facility Staff Sample/Record Review" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238180/dshs-form-10-369-attachment-k-assisted-living-facility-staff-sample-record-review-washington.png "DSHS Form 10-369 Attachment K "Assisted Living Facility Staff Sample/Record Review" - Washington")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Mandinka)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238153/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-mandinka.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Mandinka)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Korean)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238154/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-korean.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Korean)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tongan)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238155/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-tongan.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tongan)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Mongolian)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238156/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-mongolian.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Mongolian)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Samoan)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238157/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-samoan.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Samoan)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tigrinya)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238158/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-tigrinya.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tigrinya)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Somali)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238159/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-somali.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Somali)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Russian)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238160/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-russian.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Russian)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tagalog)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238163/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-tagalog.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Tagalog)")
![DSHS Formulario 03-387 "Aviso De Practicas De Privacidad De Dshs Para Informacion Medica De Clients" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238164/dshs-formulario-03-387-aviso-de-practicas-de-privacidad-de-dshs-para-informacion-medica-de-clients-washington-spanish.png "DSHS Formulario 03-387 "Aviso De Practicas De Privacidad De Dshs Para Informacion Medica De Clients" - Washington (Spanish)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Serbo-Croatian)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238166/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-serbo-croatian.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Serbo-Croatian)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Ukrainian)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238167/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-ukrainian.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Ukrainian)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Thai)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238168/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-thai.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Thai)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Nepali)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238169/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-nepali.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Nepali)")
![DSHS Form 09-653 "Background Check Authorization" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238173/dshs-form-09-653-background-check-authorization-washington.png "DSHS Form 09-653 "Background Check Authorization" - Washington")
![DSHS Formulario 09-653 "Autorizacion Para Verificacion De Antecedents" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238172/dshs-formulario-09-653-autorizacion-para-verificacion-de-antecedents-washington-spanish.png "DSHS Formulario 09-653 "Autorizacion Para Verificacion De Antecedents" - Washington (Spanish)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Punjabi)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238165/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-punjabi.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Punjabi)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Urdu)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238161/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-urdu.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Urdu)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Albanian)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238135/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-albanian.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Albanian)")
![DSHS Form 10-410 "Adult Family Home License Application" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238182/dshs-form-10-410-adult-family-home-license-application-washington.png "DSHS Form 10-410 "Adult Family Home License Application" - Washington")
![DSHS Form 10-585 "Adult Family Home Information Changes" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238185/dshs-form-10-585-adult-family-home-information-changes-washington.png "DSHS Form 10-585 "Adult Family Home Information Changes" - Washington")
![DSHS Form 01-212 "Nurse Delegation Referral and Communication" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238132/dshs-form-01-212-nurse-delegation-referral-and-communication-washington.png "DSHS Form 01-212 "Nurse Delegation Referral and Communication" - Washington")
![DSHS Form 02-716 "Rapid Response Team 2 Request" - Washington](https://data.templateroller.com/pdf_docs_html/2238/22381/2238133/dshs-form-02-716-rapid-response-team-2-request-washington.png "DSHS Form 02-716 "Rapid Response Team 2 Request" - Washington")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Lao)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238152/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-lao.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Lao)")
![DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Hindi)](https://data.templateroller.com/pdf_docs_html/2238/22381/2238151/dshs-form-03-387-dshs-notice-of-privacy-practices-for-client-medical-information-washington-hindi.png "DSHS Form 03-387 "Dshs Notice of Privacy Practices for Client Medical Information" - Washington (Hindi)")
![DSHS Form 10-653 "State Civil Penalty Reinvestment Program Grant Application - Community Residential Services and Supports (Ccrss)" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213440/dshs-form-10-653-state-civil-penalty-reinvestment-program-grant-application-community-residential-services-and-supports-ccrss-washington.png "DSHS Form 10-653 "State Civil Penalty Reinvestment Program Grant Application - Community Residential Services and Supports (Ccrss)" - Washington")
![DSHS Form 09-995 "Companion Home Certification Evaluation" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213432/dshs-form-09-995-companion-home-certification-evaluation-washington.png "DSHS Form 09-995 "Companion Home Certification Evaluation" - Washington")
![DSHS Form 10-277 "Request for Children's out-Of-Home Services" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213433/dshs-form-10-277-request-for-children-s-out-of-home-services-washington.png "DSHS Form 10-277 "Request for Children's out-Of-Home Services" - Washington")
![DSHS Form 10-231 "Adult Family Home (Afh) Referral Checklist" - Washington](https://data.templateroller.com/pdf_docs_html/2207/22079/2207934/dshs-form-10-231-adult-family-home-afh-referral-checklist-washington.png "DSHS Form 10-231 "Adult Family Home (Afh) Referral Checklist" - Washington")
![DSHS Form 06-176 "Alf Change in Licensed Resident Bed Capacity or Use of Rooms" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213426/dshs-form-06-176-alf-change-in-licensed-resident-bed-capacity-or-use-of-rooms-washington.png "DSHS Form 06-176 "Alf Change in Licensed Resident Bed Capacity or Use of Rooms" - Washington")
![DSHS Form 06-125 "Residential Allowance Request - Insufficient Income" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213428/dshs-form-06-125-residential-allowance-request-insufficient-income-washington.png "DSHS Form 06-125 "Residential Allowance Request - Insufficient Income" - Washington")
DSHS Form 06-125 "Residential Allowance Request - Insufficient Income" - Washington
Size: 192 KB
3 pages
![DSHS Form 10-468 "Hcs/Aaa/Odhh/Dda Character, Competence and Suitability (Ccs) Determination for Unsupervised Access to Minors and Vulnerable Adults" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213435/dshs-form-10-468-hcs-aaa-odhh-dda-character-competence-and-suitability-ccs-determination-for-unsupervised-access-to-minors-and-vulnerable-adults-washington.png "DSHS Form 10-468 "Hcs/Aaa/Odhh/Dda Character, Competence and Suitability (Ccs) Determination for Unsupervised Access to Minors and Vulnerable Adults" - Washington")
![DSHS Form 10-655 "Initial Staff and Family Consultation Plan" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213436/dshs-form-10-655-initial-staff-and-family-consultation-plan-washington.png "DSHS Form 10-655 "Initial Staff and Family Consultation Plan" - Washington")
![DSHS Formulario 10-655 "Plan De Consulta Inicial Para El Personal Y La Familia" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2213/22134/2213437/dshs-formulario-10-655-plan-de-consulta-inicial-para-el-personal-y-la-familia-washington-spanish.png "DSHS Formulario 10-655 "Plan De Consulta Inicial Para El Personal Y La Familia" - Washington (Spanish)")
![DSHS Form 10-657 "Initial Specialized Habilitation Plan" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213438/dshs-form-10-657-initial-specialized-habilitation-plan-washington.png "DSHS Form 10-657 "Initial Specialized Habilitation Plan" - Washington")
![DSHS Form 11-134 "Deaf-Blind Referral Criteria Checklist for Level 4 Crp Services" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213446/dshs-form-11-134-deaf-blind-referral-criteria-checklist-for-level-4-crp-services-washington.png "DSHS Form 11-134 "Deaf-Blind Referral Criteria Checklist for Level 4 Crp Services" - Washington")
![DSHS Form 02-566 "Protected Health Information (Phi) Amendment" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213423/dshs-form-02-566-protected-health-information-phi-amendment-washington.png "DSHS Form 02-566 "Protected Health Information (Phi) Amendment" - Washington")
![DSHS Form 03-506 "Character, Competence, and Suitability Assessment" - Washington](https://data.templateroller.com/pdf_docs_html/2213/22134/2213424/dshs-form-03-506-character-competence-and-suitability-assessment-washington.png "DSHS Form 03-506 "Character, Competence, and Suitability Assessment" - Washington")
DSHS Form 03-506 "Character, Competence, and Suitability Assessment" - Washington
Size: 188 KB
4 pages
