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 Sort descending Division Language Release Date File Type Available to Order
F-01234 Explanation of Medical Benefits DMS English 04/2018 PDF
F-01234 Explanation of Medical Benefits DMS English 04/2018 Word
F-02296 F-02296, Medicaid Fraud Control Elder Abuse Unit Referral: Used in Partnership with HMOs, MCOs, and IRIS OIG English 10/2019 Word
F-02296B F-02296B, Medicaid Fraud Control Elder Abuse Unit Referral Feedback: Used in Partnership with HMOs, MCOs, and IRIS OIG English 10/2019 Word
F-02296C F-02296C, Medicaid Fraud Control Elder Abuse Unit Referral: Overpayment Recovery OIG English 02/2020 Word
F-02296I F-02296i,Instructions: Medicaid Fraud Control Elder Abuse Unit Referral: Used in Partnership with HMOs and MCOs OIG English 10/2019 PDF
F-02296II F-02296ii,Instructions: Medicaid Fraud Control Elder Abuse Unit Referral: Used in Partnership with IRIS OIG English 10/2019 PDF
F-11023 F-11023, F-11023B, and F-11023C: Cost Report for Provider-Based Rural Health Clinics DMS English 06/2024 Excel
F-11023BI F-11023BI: Cost Report for Provider-Based Rural Health Clinics (Affiliated Hospital Having 50 or Fewer Beds) Instructions DMS English 06/2024 PDF
F-11023I F-11023I: Cost Report for Provider-Based Rural Health Clinics Instructions DMS English 06/2024 PDF
F-02500 Facility Referral to ADRC/Tribal ADRS for Publicly Funded Long-Term Care DPH English 12/2020 Word
F-03215 Facility Request For DHS Connect Viewer Access DCTS English 08/2023 Word
F-03146 Facility Request for DHS Connect Viewer Access DCTS English 05/2023 Word
F-05103 Facts About Your Child's Birth Certificate DPH English 03/2024 PDF
F-05103H Facts About Your Child's Birth Certificate, Hmong DPH Hmong 03/2024 PDF
F-05103S Facts About Your Child's Birth Certificate, Spanish DPH Spanish 03/2024 PDF
F-00395 Family Care / Family Care Partnership Prevocational Services Six-Month Progress Report and Service Plan DMS English 12/2018 Word
F-00221 Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions DPH English 02/2024 Word
F-00221 Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions (DocuSign) DPH English 02/2024 HTML
F-00221LP Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions (Large Print) DPH English 02/2024 Word
F-00221AR Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Arabic DPH Arabic 02/2024 PDF
F-00221CM Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word
F-00221H Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Hmong DPH Hmong 02/2024 Word
F-00221L Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Laotian DPH Laotian 02/2024 Word
F-00221R Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Russian DPH Russian 02/2024 Word
F-00221SE Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word
F-00221SO Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Somali DPH Somali 02/2024 Word
F-00221S Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions, Spanish DPH Spanish 02/2024 Word
F-02558 Family Care Member County Notification DMS English 09/2020 Word
F-02738 Family Care Partnership Appeal Decision Letter DMS English 10/2020 Word
F-02739 Family Care Partnership Letter about Your Right to Make a Fast Complaint DMS English 10/2020 Word
F-00046 Family Care Program: Enrollment DPH English 02/2024 Word
F-00046 Family Care Program: Enrollment (DocuSign) DPH English 02/2024 HTML
F-00046LP Family Care Program: Enrollment (Large Print) DPH English 02/2024 Word
F-00046AR Family Care Program: Enrollment, Arabic DPH Arabic 02/2024 PDF
F-00046CM Family Care Program: Enrollment, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word
F-00046H Family Care Program: Enrollment, Hmong DPH Hmong 02/2024 Word
F-00046L Family Care Program: Enrollment, Laotian DPH Laotian 02/2024 Word
F-00046R Family Care Program: Enrollment, Russian DPH Russian 02/2024 Word
F-00046SE Family Care Program: Enrollment, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word
F-00046SO Family Care Program: Enrollment, Somali DPH Somali 02/2024 Word
F-00046S Family Care Program: Enrollment, Spanish DPH Spanish 02/2024 Word
F-01284 Family Care, Family Care Partnership, and PACE Financial Reporting DMS English 05/2024 Excel
F-02403 Family Care, Partnership, PACE, and IRIS Program Requested Disenrollment DPH English 10/2024 Word
F-02404 Family Care, Partnership, PACE, or IRIS Change Routing Instructions DPH English 05/2023 Word
F-02720 Family Caregiver Support Program Initial Evaluation DPH English 03/2021 Word
F-02720 Family Caregiver Support Program Initial Evaluation, Spanish DPH Spanish 03/2021 Word
F-02720A Family Caregiver Support Program Post Evaluation DPH English 03/2021 Word
F-02720AS Family Caregiver Support Program Post Evaluation, Spanish DPH Spanish 03/2021 Word
F-00356 Family Planning Only Services Authorization for Electronic Data Transfer of Application DMS English 06/2019 PDF

Glossary

 
Last revised December 4, 2024