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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-00250 Pharmacy Services Lock-In Program Request for Review of Member Prescription Drug Use DMS English 03/2023 Word No
F-00250 Pharmacy Services Lock-In Program Request for Review of Member Prescription Drug Use DMS English 03/2023 PDF No
F-13074 Pharmacy Special Handling Request DMS English 04/2014 Word No
F-13074 Pharmacy Special Handling Request DMS English 04/2014 PDF No
F-13074A Pharmacy Special Handling Request: Completion Instructions DMS English 07/2012 PDF No
F-00614 Physician, Physician Assistant, and Registered Nurse Equivalency Application DPH English 09/2019 Word No
F-62333 Plan Approval Application DQA English 08/2024 Word No
F-20934A Plan Recommendation DCTS English 03/2017 PDF No
F-20934A Plan Recommendation, Spanish DCTS Spanish 03/2017 PDF No
F-62590 Post Onsite Review Questionnaire - Nurse Aide Training Programs DQA English 07/2008 PDF No
F-62590 Post Onsite Review Questionnaire - Nurse Aide Training Programs DQA English 07/2008 Word No
F-01413 Post-Assessment Questionnaire DPH English 03/2016 Word No
F-00036 Power of Attorney for Finance and Property DPH English 09/2010 HTML No
F-00603 PPS (Program Participation System) Core Module DES English 04/2012 Word No
F-00588 PPS Alcohol and Other Drug Abuse Module DCTS English 06/2019 Word No
F-00588A PPS AODA Deskcard DCTS English 02/2019 PDF No
F-00603A PPS Core Deskcard DES English 04/2013 PDF No
F-00596A PPS Mental Health Deskcard DCTS English 07/2018 PDF No
F-00596 PPS Mental Health Module DCTS English 06/2019 Word No
F-01412 Pre-Assessment Questionnaire DPH English 03/2016 Word No
F-02237 Pre-Hire Driving Record Review DES English 01/2022 Word No
F-02702 Pre-Release Enrollment Agreement DPH English 02/2024 Word No
F-02702 Pre-Release Enrollment Agreement (DocuSign) DPH English 02/2024 HTML No
F-01341 Pre-Release from Institution Checklist (CM Checklist) DCTS English 09/2016 Word No
F-01332 Predispositional Investigation Report (PDI) DCTS English 09/2016 Word No
F-00401 Preferred Drug List (PDL) Expedited Emergency Supply Request DMS English 01/2021 Word No
F-00401 Preferred Drug List (PDL) Expedited Emergency Supply Request DMS English 01/2021 PDF No
F-00401A Preferred Drug List (PDL) Expedited Emergency Supply Request, Instructions DMS English 01/2021 PDF No
F-03185 Prenatal Care Coordination Care Coordinator Visit Checklist DMS English 06/2023 PDF No
F-03185 Prenatal Care Coordination Care Coordinator Visit Checklist DMS English 06/2023 Word No
F-03183 Prenatal Care Coordination Care Plan DMS English 06/2023 PDF No
F-03183 Prenatal Care Coordination Care Plan DMS English 06/2023 Word No
F-03183A Prenatal Care Coordination Care Plan, Instructions DMS English 06/2023 PDF No
F-03186 Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring DMS English 12/2023 PDF No
F-03186 Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring DMS English 12/2023 Word No
F-03186A Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring, Instructions DMS English 12/2023 PDF No
F-03188 Prenatal Care Coordination Plan of Operation DMS English 06/2023 Word No
F-03188 Prenatal Care Coordination Plan of Operation DMS English 06/2023 PDF No
F-02774 Prenatal Care Coordination Postpartum Assessment Tool DPH English 05/2021 Word No
F-01105 Prenatal Care Coordination Pregnancy Questionnaire DMS English 07/2024 PDF No
F-01105 Prenatal Care Coordination Pregnancy Questionnaire DMS English 07/2024 Word No
F-01105A Prenatal Care Coordination Pregnancy Questionnaire Instructions DMS English 07/2024 PDF No
F-01105AH Prenatal Care Coordination Pregnancy Questionnaire Instructions, Hmong DMS Hmong 07/2024 PDF No
F-01105AS Prenatal Care Coordination Pregnancy Questionnaire Instructions, Spanish DMS Spanish 07/2024 PDF No
F-01105H Prenatal Care Coordination Pregnancy Questionnaire, Hmong DMS Hmong 07/2024 PDF No
F-01105H Prenatal Care Coordination Pregnancy Questionnaire, Hmong DMS English 07/2024 Word No
F-01105S Prenatal Care Coordination Pregnancy Questionnaire, Spanish DMS English 07/2024 Word No
F-01105S Prenatal Care Coordination Pregnancy Questionnaire, Spanish DMS Spanish 07/2024 PDF No
F-03187 Prenatal Care Coordination Referral DMS English 12/2023 PDF No
F-03187 Prenatal Care Coordination Referral DMS English 12/2023 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