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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-01205CKA IRIS Participant Education: One-Time Expense Requests, Karen DMS Karen 11/2019 PDF No
F-01205CKR IRIS Participant Education: One-Time Expense Requests, Korean DMS Korean 11/2019 PDF No
F-01205CR IRIS Participant Education: One-Time Expense Requests, Russian DMS Russian 11/2019 Word No
F-01205CS IRIS Participant Education: One-Time Expense Requests, Spanish DMS Spanish 11/2019 Word No
F-01205J IRIS Participant Education: Self-Directed Personal Care DMS English 02/2017 Word No
F-01205JAR IRIS Participant Education: Self-Directed Personal Care, Arabic DMS Arabic 02/2017 PDF No
F-01205JH IRIS Participant Education: Self-Directed Personal Care, Hmong DMS Hmong 02/2017 Word No
F-01205JKA IRIS Participant Education: Self-Directed Personal Care, Karen DMS Karen 02/2017 PDF No
F-01205JKR IRIS Participant Education: Self-Directed Personal Care, Korean DMS Korean 02/2017 PDF No
F-01205JR IRIS Participant Education: Self-Directed Personal Care, Russian DMS Russian 02/2017 Word No
F-01205JS IRIS Participant Education: Self-Directed Personal Care, Spanish DMS Spanish 02/2017 Word No
F-01201C IRIS Participant Employer / Participant - Hired Worker Agreement DMS English 02/2017 Word No
F-01201CH IRIS Participant Employer / Participant - Hired Worker Agreement, Hmong DMS Hmong 02/2017 Word No
F-01201CR IRIS Participant Employer / Participant - Hired Worker Agreement, Russian DMS Russian 02/2017 Word No
F-01201CS IRIS Participant Employer / Participant - Hired Worker Agreement, Spanish DMS Spanish 02/2017 Word No
F-01201A IRIS Participant-Hired Worker Relationship Identification DMS English 03/2023 Word No
F-01201AH IRIS Participant-Hired Worker Relationship Identification, Hmong DMS Hmong 03/2023 Word No
F-01201AR IRIS Participant-Hired Worker Relationship Identification, Russian DMS Russian 03/2023 Word No
F-01201AS IRIS Participant-Hired Worker Relationship Identification, Spanish DMS Spanish 03/2023 Word No
F-01201 IRIS Participant-Hired Worker Set-Up DMS English 09/2020 Word No
F-01201H IRIS Participant-Hired Worker Set-Up, Hmong DMS Hmong 09/2020 Word No
F-01201R IRIS Participant-Hired Worker Set-Up, Russian DMS Russian 09/2020 Word No
F-01201S IRIS Participant-Hired Worker Set-Up, Spanish DMS Spanish 09/2020 Word No
F-02833 IRIS Performance Improvement Project Annual Report DMS English 07/2021 PowerPoint No
F-01310A IRIS Program Conflict of Interest Disclosure - Participant DMS English 02/2017 Word No
F-01310 IRIS Program Conflict of Interest Disclosure - Provider DMS English 02/2017 Word No
F-01200 IRIS Program Cost Share Repayment Agreement DMS English 02/2017 Word No
F-01314 IRIS Program Employment Checklist DMS English 02/2017 Word No
F-02432 IRIS Program HIPAA Breach and Unauthorized Disclosure Reporting DMS English 10/2022 Word No
F-01309 IRIS Program Orientation and Enrollment Checklist DMS English 04/2019 Word No
F-01312 IRIS Provider Application DMS English 12/2022 Word No
F-01203 IRIS Provider Education - Health and Safety - Incident Reporting DMS English 02/2017 Word No
F-03197 IRIS SDPC - Prior Authorization Notification - Transfer from MAPC to IRIS SDPC DMS English 07/2023 Word No
F-01566 IRIS Self-Directed Personal Care (SDPC) - My Cares DMS English 02/2020 Word No
F-01258 IRIS Self-Directed Personal Care (SDPC) Disclosure Statement DMS English 06/2019 Word No
F-01258FR IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, French DMS French 06/2019 Word No
F-01258S IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, Spanish DMS Spanish 06/2019 Word No
F-01319D IRIS Self-Directed Personal Care (SDPC) Involuntary Disenrollment Request DMS English 02/2017 Word No
F-01578A IRIS SharePoint - Request for User Setup DMS English 06/2024 Word No
F-03342 IV Ketamine Infusion Therapy Attestation DMS English 01/2025 Word No
F-03342 IV Ketamine Infusion Therapy Attestation DMS English 01/2025 PDF No
F-00989M Justification for Services Provided in Locations Other than Natural Environments (IFSP) DMS English 02/2017 Word No
F-00989MS Justification for Services Provided in Locations Other than Natural Environments (IFSP), Spanish DMS Spanish 02/2017 Word No
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 PDF No
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 Word No
F-03144 Katie Beckett Medicaid Disability Redetermination: Provider Information DMS English 09/2024 Word No
F-03144H Katie Beckett Medicaid Disability Redetermination: Provider Information, Hmong DMS Hmong 09/2024 Word No
F-03144S Katie Beckett Medicaid Disability Redetermination: Provider Information, Spanish DMS Spanish 09/2024 Word No
F-03096 Katie Beckett Release of Information DMS English 05/2023 Word No
F-03096 Katie Beckett Release of Information DMS English 05/2023 PDF 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