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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-02074 Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF No
F-02074 Medicare Other Coverage Discrepancy Report DMS English 04/2018 Word No
F-00855 Medication Therapy Management Case Management Software Requirements DMS English 08/2014 PDF No
F-00855A Medication Therapy Management Case Management Software Vendor Steps for Software Approval Process DMS English 08/2013 PDF No
F-13026 Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums DMS English 05/2024 PDF No
F-13026S Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums, Spanish DMS Spanish 05/2024 PDF No
F-13023 Member / Employer Electronic Funds Transfer for Medicaid Purchase Plan Premiums DMS English 05/2024 PDF No
F-01915A Member Request Gap Filling Eligibility Determinations Supplemental Letter DMS English 07/2017 Word No
F-03313 Mental Health and Substance Use Changes to Provider Information DQA English 12/2024 Word No
F-00251 Mental Health Block Grant Community Aids Allocation Report DCTS English 01/2023 HTML No
F-11090 Mental Health Day Treatment Functional Assessment DMS English 08/2015 Word No
F-11090 Mental Health Day Treatment Functional Assessment DMS English 08/2015 PDF No
F-11090A Mental Health Day Treatment Functional Assessment: Completion Instructions DMS English 08/2015 PDF No
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA English 11/2011 Word No
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA English 11/2011 PDF No
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA English 12/2011 Word No
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA English 12/2011 PDF No
F-00380 Mental Health or Substance Use Treatment Provider Closing Certification DQA English 12/2024 Word No
F-01389 MHSIP Adult Satisfaction Survey DCTS English 08/2022 PDF No
F-01389H MHSIP Adult Satisfaction Survey, Hmong DCTS Hmong 08/2022 PDF No
F-01389KH MHSIP Adult Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 08/2022 PDF No
F-01389L MHSIP Adult Satisfaction Survey, Laotian DCTS Laotian 08/2022 PDF No
F-01389NE MHSIP Adult Satisfaction Survey, Nepali DCTS Nepali 08/2022 PDF No
F-01389SO MHSIP Adult Satisfaction Survey, Somali DCTS Somali 08/2022 PDF No
F-01389S MHSIP Adult Satisfaction Survey, Spanish DCTS Spanish 08/2022 PDF No
F-01389B MHSIP Family Satisfaction Survey DCTS English 09/2021 PDF No
F-01389BH MHSIP Family Satisfaction Survey, Hmong DCTS Hmong 09/2021 PDF No
F-01389BKH MHSIP Family Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 09/2021 PDF No
F-01389BL MHSIP Family Satisfaction Survey, Laotian DCTS Laotian 09/2021 PDF No
F-01389BNE MHSIP Family Satisfaction Survey, Nepali DCTS Nepali 09/2021 PDF No
F-01389BSO MHSIP Family Satisfaction Survey, Somali DCTS Somali 09/2021 PDF No
F-01389BS MHSIP Family Satisfaction Survey, Spanish DCTS Spanish 09/2021 PDF No
F-01389A MHSIP Youth Satisfaction Survey DCTS English 09/2021 PDF No
F-01389AH MHSIP Youth Satisfaction Survey, Hmong DCTS Hmong 09/2021 PDF No
F-01389AKH MHSIP Youth Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 09/2021 PDF No
F-01389AL MHSIP Youth Satisfaction Survey, Laotian DCTS Laotian 09/2021 PDF No
F-01389ANE MHSIP Youth Satisfaction Survey, Nepali DCTS Nepali 09/2021 PDF No
F-01389ASO MHSIP Youth Satisfaction Survey, Somali DCTS Somali 09/2021 PDF No
F-01389AS MHSIP Youth Satisfaction Survey, Spanish DCTS Spanish 09/2021 PDF No
F-03210 MI Team Survey DCTS English 08/2023 HTML No
F-02258 Minority Health Advisory Committee Application DPH English 01/2018 Word No
F-01930 Minority Health Advisory Group Nomination and Agreement DPH English 11/2016 Word No
F-02388 MIPPA Grant Agency Application DPH English 09/2020 HTML No
F-62447 Misconduct Incident Report DQA English 03/2024 PDF No
F-62447 Misconduct Incident Report DQA English 03/2024 Word No
F-62674A Model Balance Sheet DQA English 10/2023 PDF No
F-62674A Model Balance Sheet DQA English 10/2023 Word No
F-00334 Money Follows the Person (MFP) - Participant Reporting DMS English 03/2017 PDF No
F-00334 Money Follows the Person (MFP) - Participant Reporting DMS English 03/2017 Word No
F-03029 Moving Forward Together Grant Request for Application (RFA) DPH English 04/2022 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