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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-02886 Performance Improvement Project Annual Report Format Guideline DMS English 12/2022 Word No
F-11136 Personal Care Addendum DMS English 10/2008 Word No
F-11136 Personal Care Addendum DMS English 10/2008 PDF No
F-11136A Personal Care Addendum Completion Instructions DMS English 10/2008 PDF No
F-03264 Personal Care Agency (PCA) - Branch Office Request DQA English 01/2024 Word No
F-00119 Personal Care Agency Application DQA English 03/2024 Word No
F-00262 Personal Care Agency Application Materials Checklist DQA English 09/2024 Word No
F-00262A Personal Care Agency Certification Application Checklist DQA English 09/2024 Word No
F-00784 Personal Care Agency Client Rights DQA English 08/2016 PDF No
F-00784 Personal Care Agency Client Rights DQA English 08/2016 Word No
F-62069A Personal Care Agency Complaint Report DQA English 08/2023 Word No
F-62274A Personal Care Agency Consent for Home Visit DQA English 05/2013 PDF No
F-62274AH Personal Care Agency Consent for Home Visit, Hmong DQA Hmong 05/2013 PDF No
F-62274AS Personal Care Agency Consent for Home Visit, Spanish DQA Spanish 05/2013 PDF No
F-62652A Personal Care Agency Home Visit Guide DQA English 06/2010 Word No
F-62652A Personal Care Agency Home Visit Guide DQA English 06/2010 PDF No
F-00261 Personal Care Agency Personnel Record Review DQA English 11/2022 PDF No
F-00261 Personal Care Agency Personnel Record Review DQA English 06/2010 Word No
F-00263 Personal Care Agency Record Review DQA English 10/2022 PDF No
F-00263 Personal Care Agency Record Review DQA English 10/2022 Word No
F-62648A Personal Care Agency Sample Selection DQA English 06/2010 PDF No
F-62648A Personal Care Agency Sample Selection DQA English 06/2010 Word No
F-00909 Personal Care Consumer Survey DQA English 11/2013 HTML No
F-11134 Personal Care Prior Authorization Provider Acknowledgement DMS English 07/2012 PDF No
F-11134 Personal Care Prior Authorization Provider Acknowledgement DMS English 07/2012 Word No
F-11271 Personal Care Provider Addendum DMS English 09/2019 PDF No
F-11271 Personal Care Provider Addendum DMS English 09/2019 Word No
F-11133 Personal Care Screening Tool (PCST) DMS English 11/2024 Word No
F-11133 Personal Care Screening Tool (PCST) DMS English 11/2024 PDF No
F-11133A Personal Care Screening Tool (PCST) Instructions DMS English 11/2024 PDF No
F-02645 Personal Protective Equipment (PPE) Reserve Request DPH English 04/2020 Word No
F-02645 Personal Protective Equipment (PPE) Reserve Request DPH English 04/2020 PDF No
F-44236 Pertussis Case Report DPH English 05/2004 PDF No
F-62537 Petition for Building Code Variance DQA English 01/2018 Word No
F-62537 Petition for Building Code Variance DQA English 01/2018 PDF No
F-25206 Petition for Capias DCTS English 03/2021 Word No
F-25206 Petition for Capias DCTS English 03/2021 PDF No
F-25393 Petition for Conditional Release DCTS English 01/2017 Word No
F-25392 Petition for Re-examination DCTS English 01/2017 Word No
F-25393A Petition for Supervised Release DCTS English 05/2018 Word No
F-02061 Pharmacy Benefit Manager (PBM) Insurance Disclosure Onboarding DMS English 03/2017 PDF No
F-00841 Pharmacy Services Lock-In Program - HMO Referral for Pharmacy Services Lock-In of HMO Member DMS English 03/2023 Word No
F-00841 Pharmacy Services Lock-In Program - HMO Referral for Pharmacy Services Lock-In of HMO Member DMS English 03/2023 PDF No
F-00840 Pharmacy Services Lock-In Program - HMO Responsibilities for Member Referral to Pharmacy Services Lock-In Program DMS English 03/2023 Word No
F-00840 Pharmacy Services Lock-In Program - HMO Responsibilities for Member Referral to Pharmacy Services Lock-In Program DMS English 03/2023 PDF No
F-00842 Pharmacy Services Lock-In Program - Program Summary DMS English 07/2013 PDF No
F-11183 Pharmacy Services Lock-In Program / Designation of Alternate Prescriber for Restricted Medications Services DMS English 03/2023 PDF No
F-11183 Pharmacy Services Lock-In Program / Designation of Alternate Prescriber for Restricted Medications Services DMS English 03/2023 Word No
F-00345 Pharmacy Services Lock-In Program HMO Designation of Prescriber for Restricted Medication Services DMS English 03/2023 PDF No
F-00345 Pharmacy Services Lock-In Program HMO Designation of Prescriber for Restricted Medication Services DMS English 03/2023 Word 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