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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-00004 Health and Employment Counseling Application DMS English 11/2023 PDF No
F-00004H Health and Employment Counseling Application, Hmong DMS Hmong 11/2023 PDF No
F-00004S Health and Employment Counseling Application, Spanish DMS Spanish 11/2023 PDF No
F-00004B Health and Employment Counseling Employment Report DMS English 11/2023 PDF No
F-00004BH Health and Employment Counseling Employment Report, Hmong DMS Hmong 11/2023 PDF No
F-00004BS Health and Employment Counseling Employment Report, Spanish DMS Spanish 11/2023 PDF No
F-00004A Health and Employment Counseling Extension Request DMS English 11/2023 PDF No
F-00004AH Health and Employment Counseling Extension Request, Hmong DMS Hmong 11/2023 PDF No
F-00004AS Health and Employment Counseling Extension Request, Spanish DMS Spanish 11/2023 PDF No
F-43006 Health Care Employer Assurance for J-1 Visa Waiver Applications DPH English 10/2018 PDF No
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 Word No
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 PDF No
F-62500 Health Care Facility Fire Report DQA English 10/2018 HTML No
F-03276 Health Information Exchange Patient Choice DCTS English 03/2024 PDF No
F-01062 HealthCheck Adolescent Review DMS English 08/2019 PDF No
F-01062 HealthCheck Adolescent Review DMS English 08/2019 Word No
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 PDF No
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 Word No
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 PDF No
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 Word No
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 Word No
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 PDF No
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age DMS English 07/2008 PDF No
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age DMS English 07/2008 Word No
F-01066AS HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish DMS Spanish 07/2008 Word No
F-01066AS HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish DMS Spanish 07/2008 PDF No
F-11289 HealthCheck County Outreach Case Management Plan for County DMS English 09/2019 Word No
F-11289 HealthCheck County Outreach Case Management Plan for County DMS English 09/2019 PDF No
F-01063 HealthCheck Family History DMS English 08/2017 PDF No
F-01063 HealthCheck Family History DMS English 08/2017 Word No
F-01063S HealthCheck Family History, Spanish DMS Spanish 08/2017 Word No
F-01063S HealthCheck Family History, Spanish DMS Spanish 08/2017 PDF No
F-01002 HealthCheck Individual Health History DMS English 08/2019 PDF No
F-01002 HealthCheck Individual Health History DMS English 08/2019 Word No
F-01002H HealthCheck Individual Health History, Hmong DMS Hmong 08/2019 Word No
F-01002H HealthCheck Individual Health History, Hmong DMS Hmong 08/2019 PDF No
F-01002S HealthCheck Individual Health History, Spanish DMS Spanish 08/2019 PDF No
F-01002S HealthCheck Individual Health History, Spanish DMS Spanish 08/2019 Word No
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS English 07/2008 PDF No
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS English 07/2008 Word No
F-01066S HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish DMS Spanish 07/2008 PDF No
F-01066S HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish DMS Spanish 07/2008 Word No
F-00021 HealthCheck Referral DMS English 01/2017 PDF No
F-11285 HealthCheck Screener Affirmation OIG English 04/2022 Word No
F-11285 HealthCheck Screener Affirmation OIG English 04/2022 PDF No
F-01067 HealthCheck Your Child's Speech and Hearing DMS English 07/2008 PDF No
F-01067 HealthCheck Your Child's Speech and Hearing DMS English 07/2008 Word No
F-03004 Healthy Heart Ambassador Blood Pressure Self-Monitoring Program Exit Survey DPH English 03/2022 HTML No
F-22554 Hearing Loss Certification Telecommunications Assistance Program (TAP) DPH English 08/2024 PDF No
F-22554 Hearing Loss Certification Telecommunications Assistance Program (TAP) DPH English 08/2024 HTML 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.

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Last revised December 4, 2024