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-80983AH Instructions - Completing the Civil Rights Complaint, Hmong OLC Hmong 04/2024 PDF
F-80983AS Instructions - Completing the Civil Rights Complaint, Spanish OLC Spanish 04/2024 PDF
F-20582I Instructions for Completing the Application for Katie Beckett Medicaid DMS English 03/2023 PDF
F-20582IH Instructions for Completing the Application for Katie Beckett Medicaid, Hmong DMS Hmong 03/2023 PDF
F-20582IS Instructions for Completing the Application for Katie Beckett Medicaid, Spanish DMS Spanish 03/2023 PDF
F-00989I Instructions for Completing Wisconsin's Individualized Family Service Plan (IFSP) DMS English 03/2017 PDF
F-00950I Instructions for Coverage Decision Letter DMS English 01/2024 PDF
F-03112I Instructions for Logging HMO Appeals DMS English 01/2024 PDF
F-02466I Instructions for Logging MCO Appeals DMS English 12/2022 PDF
F-02466AI Instructions for Logging MCO Grievances DMS English 12/2022 PDF
F-00232I Instructions for Notice of Adverse Benefit Determination (Notice of Action) DMS English 12/2021 PDF
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 PDF
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 Word
F-00539 Instructions for the County Waiver Agency Support and Service Coordination (SSC) Rates DMS English 09/2019 PDF
F-00202I Instructions – Individual Service Plan – Community Recovery Services (CRS) DCTS English 08/2016 PDF
F-00107 Instructions, Self-Employment Income Report DMS English 06/2019 PDF
F-00107ACM Instructions, Self-Employment Income Report, Chinese (Simplified) DMS Chinese (Simplified) 06/2019 PDF
F-00107 Instructions, Self-Employment Income Report, Hmong DMS Hmong 06/2019 PDF
F-00107 Instructions, Self-Employment Income Report, Spanish DMS Spanish 06/2019 PDF
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records DMS English 02/2017 PDF
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish DMS Spanish 02/2017 PDF
F-02717A Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 04/2023 PDF
F-02717AH Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong DMS Hmong 04/2023 PDF
F-02717AS Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish DMS Spanish 04/2023 PDF
F-01234A Instructions: Explanation of Medical Benefits DMS English 11/2023 PDF
F-16030B Instructions: FoodShare Wisconsin Overpayment Calculator DMS English 01/2018 PDF
F-02382I Instructions: HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet DMS English 10/2020 PDF
F-10110A Instructions: Medicaid/BadgerCare Plus Eligibility Certification DMS English 01/2018 HTML
F-02074A Instructions: Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF
F-11010A Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2018 PDF
F-11008A Instructions: Prior Authorization / Therapy Attachment (PA/TA) DMS English 07/2024 PDF
F-01248A Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF
F-22637 Interagency Notification -Termination of Community Waiver Participation DMS English 03/2017 PDF
F-10142 Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant DMS English 07/2008 PDF
F-42010 Interjurisdictional Tuberculosis Notification DPH English 03/2003 PDF
F-42011 Interjurisdictional Tuberculosis Notification - Follow-up DPH English 03/2003 PDF
F-47463D Intermediate Operational Plan Components DPH English 06/2012 PDF
F-47463C Intermediate Technician Operational Plan Components DPH English 06/2012 PDF
F-03010 Intoxicated Driver Program Assessor Training Application DCTS English 03/2022 HTML
F-01761 Intoxicated Driver Program Self-Evaluation DCTS English 09/2016 Word
F-20891 Intoxicated Driver Program Supplemental Funding Request DCTS English 08/2024 Word
F-02961 Introduction to Community Recovery Services Presentation Evaluation Survey DCTS English 02/2022 HTML
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization DPH English 02/2024 Word
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization (DocuSign) DPH English 02/2024 HTML
F-00075LP IRIS (Include, Respect, I Self-Direct) Authorization (Large Print) DPH English 02/2024 Word
F-00075AR IRIS (Include, Respect, I Self-Direct) Authorization, Arabic DPH Arabic 02/2024 PDF
F-00075CM IRIS (Include, Respect, I Self-Direct) Authorization, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word
F-00075H IRIS (Include, Respect, I Self-Direct) Authorization, Hmong DPH Hmong 02/2024 Word
F-00075L IRIS (Include, Respect, I Self-Direct) Authorization, Laotian DPH Laotian 02/2024 Word
F-00075R IRIS (Include, Respect, I Self-Direct) Authorization, Russian DPH Russian 02/2024 Word

Glossary

 
Last revised December 4, 2024