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Documents
1879
![DSHS Form 14-001 "Application for Cash or Food Assistance" - Washington (Lao)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069548/dshs-form-14-001-application-for-cash-or-food-assistance-washington-lao.png "DSHS Form 14-001 "Application for Cash or Food Assistance" - Washington (Lao)")
![DSHS Form 10-326 "Staffed Residential Rate Proposal" - Washington](https://data.templateroller.com/pdf_docs_html/2080/20805/2080532/dshs-form-10-326-staffed-residential-rate-proposal-washington.png "DSHS Form 10-326 "Staffed Residential Rate Proposal" - Washington")
![DSHS Formulario 07-097 "Aviso De Accion Planificada Del Proveedor Individual (Ip) Sobre Capacitacion/Certificacion" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069510/dshs-formulario-07-097-aviso-de-accion-planificada-del-proveedor-individual-ip-sobre-capacitacion-certificacion-washington-spanish.png "DSHS Formulario 07-097 "Aviso De Accion Planificada Del Proveedor Individual (Ip) Sobre Capacitacion/Certificacion" - Washington (Spanish)")
![DSHS Form 10-353 "Documentation Request for Medical Condition and Residual Functional Capacity" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069515/dshs-form-10-353-documentation-request-for-medical-condition-and-residual-functional-capacity-washington.png "DSHS Form 10-353 "Documentation Request for Medical Condition and Residual Functional Capacity" - Washington")
![DSHS Form 05-273 "Private Duty Nursing (Pdn) Pre-contract Education Attestation" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20694/2069498/dshs-form-05-273-private-duty-nursing-pdn-pre-contract-education-attestation-washington.png "DSHS Form 05-273 "Private Duty Nursing (Pdn) Pre-contract Education Attestation" - Washington")
![DSHS Form 10-331 "Dda Mortality Review Provider Report" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069513/dshs-form-10-331-dda-mortality-review-provider-report-washington.png "DSHS Form 10-331 "Dda Mortality Review Provider Report" - Washington")
![DSHS Form 10-410 "Adult Family Home License Application" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069517/dshs-form-10-410-adult-family-home-license-application-washington.png "DSHS Form 10-410 "Adult Family Home License Application" - Washington")
![DSHS Form 27-188 "Initial Opiate Prescription Informed Consent" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20696/2069601/dshs-form-27-188-initial-opiate-prescription-informed-consent-washington.png "DSHS Form 27-188 "Initial Opiate Prescription Informed Consent" - Washington")
![DSHS Form 14-012 "Consent" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069546/dshs-form-14-012-consent-washington.png "DSHS Form 14-012 "Consent" - Washington")
![DSHS Form 11-119 "Informational Interview Worksheet" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069535/dshs-form-11-119-informational-interview-worksheet-washington.png "DSHS Form 11-119 "Informational Interview Worksheet" - Washington")
![DSHS Form 11-114 "Pre-ets Student Sign-In Roster" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069534/dshs-form-11-114-pre-ets-student-sign-in-roster-washington.png "DSHS Form 11-114 "Pre-ets Student Sign-In Roster" - Washington")
![DSHS Form 13-926 "Forensic (6358) Consultation" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069544/dshs-form-13-926-forensic-6358-consultation-washington.png "DSHS Form 13-926 "Forensic (6358) Consultation" - Washington")
![DSHS Form 07-097 "Individual Provider Planned Action Notice Training / Certification" - Washington (Somali)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069505/dshs-form-07-097-individual-provider-planned-action-notice-training-certification-washington-somali.png "DSHS Form 07-097 "Individual Provider Planned Action Notice Training / Certification" - Washington (Somali)")
![DSHS Form 10-650 "Private Duty Nursing Contract Monitoring Tool" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069529/dshs-form-10-650-private-duty-nursing-contract-monitoring-tool-washington.png "DSHS Form 10-650 "Private Duty Nursing Contract Monitoring Tool" - Washington")
![DSHS Form 13-925 "Request for Formulary Admission or Deletion" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069540/dshs-form-13-925-request-for-formulary-admission-or-deletion-washington.png "DSHS Form 13-925 "Request for Formulary Admission or Deletion" - Washington")
![DSHS Form 14-264 "Application for Telecommunication Equipment" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069559/dshs-form-14-264-application-for-telecommunication-equipment-washington.png "DSHS Form 14-264 "Application for Telecommunication Equipment" - Washington")
![DSHS Form 13-928 "Withdrawal of Petition for Conditional Release or Unconditional Release" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069545/dshs-form-13-928-withdrawal-of-petition-for-conditional-release-or-unconditional-release-washington.png "DSHS Form 13-928 "Withdrawal of Petition for Conditional Release or Unconditional Release" - Washington")
![DSHS Form 07-097 "Individual Provider (Ip) Planned Action Notice Training / Certification" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069504/dshs-form-07-097-individual-provider-ip-planned-action-notice-training-certification-washington.png "DSHS Form 07-097 "Individual Provider (Ip) Planned Action Notice Training / Certification" - Washington")
![DSHS Form 10-639 "Overnight Planned Respite Services (Oprs) Certification Evaluation" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069532/dshs-form-10-639-overnight-planned-respite-services-oprs-certification-evaluation-washington.png "DSHS Form 10-639 "Overnight Planned Respite Services (Oprs) Certification Evaluation" - Washington")
![DSHS Form 17-292 "Act Program Service Request / Work Order for Induction Loops" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069584/dshs-form-17-292-act-program-service-request-work-order-for-induction-loops-washington.png "DSHS Form 17-292 "Act Program Service Request / Work Order for Induction Loops" - Washington")
![DSHS Form 17-226 "Aaa Dshs / Hca Systems Access Request" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069582/dshs-form-17-226-aaa-dshs-hca-systems-access-request-washington.png "DSHS Form 17-226 "Aaa Dshs / Hca Systems Access Request" - Washington")
![DSHS Form 16-202 "5-day Investigation Report" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069577/dshs-form-16-202-5-day-investigation-report-washington.png "DSHS Form 16-202 "5-day Investigation Report" - Washington")
![DSHS Form 10-572 "Respite Application for Overnight Planned Respite (Oprs), Emergent and/Or Planned Short-Term Stay Services at an Rhc" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069519/dshs-form-10-572-respite-application-for-overnight-planned-respite-oprs-emergent-and-or-planned-short-term-stay-services-at-an-rhc-washington.png "DSHS Form 10-572 "Respite Application for Overnight Planned Respite (Oprs), Emergent and/Or Planned Short-Term Stay Services at an Rhc" - Washington")
![DSHS Form 14-012 "Consent" - Washington (Somali)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069550/dshs-form-14-012-consent-washington-somali.png "DSHS Form 14-012 "Consent" - Washington (Somali)")
![DSHS Form 15-388 "Alternative Living Certification Evaluation" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069570/dshs-form-15-388-alternative-living-certification-evaluation-washington.png "DSHS Form 15-388 "Alternative Living Certification Evaluation" - Washington")
![DSHS Formulario 14-012 "Autorizacion" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069549/dshs-formulario-14-012-autorizacion-washington-spanish.png "DSHS Formulario 14-012 "Autorizacion" - Washington (Spanish)")
![DSHS Form 07-097 "Individual Provider (Ip) Planned Action Notice Training / Certification" - Washington (Ukrainian)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069507/dshs-form-07-097-individual-provider-ip-planned-action-notice-training-certification-washington-ukrainian.png "DSHS Form 07-097 "Individual Provider (Ip) Planned Action Notice Training / Certification" - Washington (Ukrainian)")
![DSHS Form 10-592 "Comprehensive Functional Assessment of Direct Care Independent Living Skills" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069522/dshs-form-10-592-comprehensive-functional-assessment-of-direct-care-independent-living-skills-washington.png "DSHS Form 10-592 "Comprehensive Functional Assessment of Direct Care Independent Living Skills" - Washington")
![DSHS Formulario 10-353 "Solicitud De Documentacion Por Trastorno Medico Y Capacidad Funcional Residual" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069514/dshs-formulario-10-353-solicitud-de-documentacion-por-trastorno-medico-y-capacidad-funcional-residual-washington-spanish.png "DSHS Formulario 10-353 "Solicitud De Documentacion Por Trastorno Medico Y Capacidad Funcional Residual" - Washington (Spanish)")
![DSHS Form 10-585 "Adult Family Home Information Changes" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069520/dshs-form-10-585-adult-family-home-information-changes-washington.png "DSHS Form 10-585 "Adult Family Home Information Changes" - Washington")
![DSHS Form 06-176 "Adult Living Facility (Alf) Change in Licensed Resident Bed Capacity or Use of Rooms" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069503/dshs-form-06-176-adult-living-facility-alf-change-in-licensed-resident-bed-capacity-or-use-of-rooms-washington.png "DSHS Form 06-176 "Adult Living Facility (Alf) Change in Licensed Resident Bed Capacity or Use of Rooms" - Washington")
![DSHS Form 13-920 "Ocrp Discharge Summary" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069543/dshs-form-13-920-ocrp-discharge-summary-washington.png "DSHS Form 13-920 "Ocrp Discharge Summary" - Washington")
![DSHS Formulario 18-398 "Notificacion De Sobrepago Al Cliente" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069590/dshs-formulario-18-398-notificacion-de-sobrepago-al-cliente-washington-spanish.png "DSHS Formulario 18-398 "Notificacion De Sobrepago Al Cliente" - Washington (Spanish)")
![DSHS Formulario 18-700 "Autorizacion De Deposito Directo" - Washington (Spanish)](https://data.templateroller.com/pdf_docs_html/2069/20696/2069600/dshs-formulario-18-700-autorizacion-de-deposito-directo-washington-spanish.png "DSHS Formulario 18-700 "Autorizacion De Deposito Directo" - Washington (Spanish)")
![DSHS Form 18-398 "Client Overpayment Notice" - Washington (Cambodian)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069587/dshs-form-18-398-client-overpayment-notice-washington-cambodian.png "DSHS Form 18-398 "Client Overpayment Notice" - Washington (Cambodian)")
![DSHS Form 18-078 "Application for Nonassistance Support Enforcement Services" - Washington (Korean)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069586/dshs-form-18-078-application-for-nonassistance-support-enforcement-services-washington-korean.png "DSHS Form 18-078 "Application for Nonassistance Support Enforcement Services" - Washington (Korean)")
![DSHS Form 18-398 "Client Overpayment Notice" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069588/dshs-form-18-398-client-overpayment-notice-washington.png "DSHS Form 18-398 "Client Overpayment Notice" - Washington")
![DSHS Form 18-398 "Client Overpayment Notice" - Washington (Lao)](https://data.templateroller.com/pdf_docs_html/2069/20695/2069589/dshs-form-18-398-client-overpayment-notice-washington-lao.png "DSHS Form 18-398 "Client Overpayment Notice" - Washington (Lao)")
![DSHS Form 15-548 "Adult Family Home (Afh) Administrator Training Instructor Application" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069573/dshs-form-15-548-adult-family-home-afh-administrator-training-instructor-application-washington.png "DSHS Form 15-548 "Adult Family Home (Afh) Administrator Training Instructor Application" - Washington")
![DSHS Form 10-646 "Residential Certification Evaluation Legal Representative Interview" - Washington](https://data.templateroller.com/pdf_docs_html/2069/20695/2069526/dshs-form-10-646-residential-certification-evaluation-legal-representative-interview-washington.png "DSHS Form 10-646 "Residential Certification Evaluation Legal Representative Interview" - Washington")
Washington State Department of Social and Health Services Forms
1879
total templates