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Official DHS Forms Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions. When you are searching for a document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

Assigned Number Title Division Language Release Date File Type Available to Order
F-03030S Disability Benefit Specialist Program Case Closing Letter, Spanish DPH Spanish 05/2022 Word No
F-02562 Disability Benefit Specialist Program Client Services Agreement DPH English 02/2022 Word No
F-02562 Disability Benefit Specialist Program Client Services Agreement DPH English 02/2022 HTML No
F-02562A Disability Benefit Specialist Program Client Services Agreement, Instructions DPH English 02/2022 PDF No
F-02562LP Disability Benefit Specialist Program Client Services Agreement, Large Print DPH English 02/2022 Word No
F-02562S Disability Benefit Specialist Program Client Services Agreement, Spanish DPH Spanish 02/2022 Word No
F-02339 Disaster Response Interpreter (DRI) Deployment Checklist for Community Shelters and Media Events DPH English 06/2018 PDF No
F-03203 Disenrollment of Adult Long-Term Care (LTC) Waiver Program and Services DMS English 09/2024 Word No
F-03203 Disenrollment of Adult Long-Term Care (LTC) Waiver Program and Services DMS English 09/2024 PDF No
F-16025 Disqualification Consent Agreement DMS English 07/2023 PDF No
F-16025AR Disqualification Consent Agreement, Arabic DMS Arabic 07/2023 PDF No
F-16025CM Disqualification Consent Agreement, Chinese (Simplified) DMS Chinese (Simplified) 07/2023 PDF No
F-16025G Disqualification Consent Agreement, German DMS German 05/2018 PDF No
F-16025H Disqualification Consent Agreement, Hmong DMS Hmong 07/2023 PDF No
F-16025L Disqualification Consent Agreement, Laotian DMS Laotian 05/2018 PDF No
F-16025R Disqualification Consent Agreement, Russian DMS Russian 07/2023 PDF No
F-16025SO Disqualification Consent Agreement, Somali DMS Somali 07/2023 PDF No
F-16025S Disqualification Consent Agreement, Spanish DMS Spanish 07/2023 PDF No
F-02962 Disseminated Gonococcal Infection Provider Worksheet DPH English 02/2022 PDF No
F-10193 Divestment Penalty and Undue Hardship Notice Plus Waiver Request DMS English 08/2021 PDF No
F-10193S Divestment Penalty and Undue Hardship Notice Plus Waiver Request, Spanish DMS Spanish 08/2021 PDF No
F-00607 Division of Quality Assurance (DQA) - Misconduct Report or Complaint about Care or Treatment DQA English 02/2023 HTML No
F-44764 DNR Bracelet Insert DPH English 07/2020 PDF No
F-43025 Document of Anatomical Gift Authorization for Organ and Tissue Donation DPH English 12/2018 PDF No
F-43025S Document of Anatomical Gift Authorization for Organ and Tissue Donation, Spanish DPH Spanish 12/2018 PDF No
F-02859 DPH Speaker Request DPH English 08/2021 HTML No
F-62096A DQA Authority for Obtaining Provider Records Without Written Release DQA English 10/2018 PDF No
F-03189 DQA Corporate Guardianship Provider Agreement DQA English 10/2023 PDF No
F-62188 DQA External Request for Presenter DQA English 02/2024 HTML No
F-02426 DQA Misconduct Incident Reporting (MIR) System Account Registration Survey DQA English 11/2018 HTML No
F-02657 DQA Post Survey Questionnaire: Clinical Laboratory Improvement Amendments (CLIA) DQA English 05/2020 Word No
F-00020 Drug Addition Review Request DMS English 04/2014 PDF No
F-00020 Drug Addition Review Request DMS English 04/2014 Word No
F-62643 Drug Repository Program Notice of Participation or Withdrawal DQA English 02/2022 Word No
F-62645C Drug Repository Program: Destruction Record DQA English 05/2020 Word No
F-62645B Drug Repository Program: Donation Record DQA English 05/2020 Word No
F-62645 Drug Repository Program: Recipient Record DQA English 05/2020 Word No
F-62645 Drug Repository Program: Recipient Record DQA English 05/2020 PDF No
F-62645A Drug Repository Program: Transfer Record DQA English 05/2020 Word No
F-02891 Durable Medical Equipment Home Accessibility Report DMS English 08/2022 PDF No
F-02891 Durable Medical Equipment Home Accessibility Report DMS English 08/2022 Word No
F-40303 Early Childhood Caries Prevention Screening DPH English 10/2003 PDF No
F-00989F Early Intervention Team Report / Wisconsin Early Intervention Eligibility Determination (IFSP) DMS English 02/2017 Word No
F-00989FS Early Intervention Team Report / Wisconsin Early Intervention Eligibility Determination (IFSP), Spanish DMS Spanish 02/2017 Word No
F-01411 Education - Medication Summary - Part B DPH English 10/2017 Word No
F-01410 Education Summary DPH English 07/2022 PDF No
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil DMS English 01/2019 PDF No
F-00079A Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil Instructions DMS English 01/2019 PDF No
F-21150 Elder Adults/Adults-at-Risk Agency Conflict of Interest Notification and Transfer of Investigation Powers DPH English 07/2016 Word No
F-02717 Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 04/2023 Word No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

Glossary

 
Last revised December 4, 2024