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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-00315C Prior Notice and Consent for Evaluation and Assessment DMS English 03/2017 PDF No
F-00315C Prior Notice and Consent for Evaluation and Assessment DMS English 03/2017 Word No
F-00315C Prior Notice and Consent for Evaluation and Assessment, Spanish DMS Spanish 03/2017 PDF No
F-11252 Private Duty Nursing for Members for Ventilator-Dependent Life-Support Addendum DMS English 05/2019 Word No
F-11252 Private Duty Nursing for Members for Ventilator-Dependent Life-Support Addendum DMS English 05/2019 PDF No
F-11041 Private Duty Nursing Prior Authorization Acknowledgment DMS English 10/2008 Word No
F-11041 Private Duty Nursing Prior Authorization Acknowledgment DMS English 10/2008 PDF No
F-13033 Probate Claims Notice DMS English 05/2021 PDF No
F-80881 Profile ID Request (CARS) and Instructions DES English 11/2022 Excel No
F-02167 Program Participation System (PPS) PORTAL Report Feedback DCTS English 07/2017 Word No
F-21225A Program Participation System (PPS): B-3 Module DMS English 04/2023 PDF No
F-21225A Program Participation System (PPS): B-3 Module DMS English 04/2023 Word No
F-21225 Program Participation System (PPS): B-3 Module DMS English 11/2014 HTML No
F-21225AI Program Participation System (PPS): B-3 Module, Deskcard DMS English 04/2023 PDF No
F-00603I Program Participation System Core Instructions DES English 08/2017 PDF No
F-22540I Program Participation System Human Services Revenue Report (HSRR) Expenditures by Revenue Source for Human Service Programs – Instructions OPIB English 01/2025 PDF No
F-20942I Program Participation System: Expense Report for Human Service Programs - Instructions OPIB English 01/2025 PDF No
F-02577 Proof of In-Kind Hours DMS English 06/2023 PDF No
F-02577H Proof of In-Kind Hours, Hmong DMS Hmong 06/2023 PDF No
F-02577S Proof of In-Kind Hours, Spanish DMS Spanish 06/2023 PDF No
F-44771D Property Investigation Closure Report / Case Management of Children with Elevated Blood Lead Levels DPH English 05/2019 PDF No
F-44771C Property Investigation Report / Case Management of Children with Elevated Blood Lead Levels DPH English 05/2019 PDF No
F-16026 Prosecution Diversion Agreement DMS English 05/2018 PDF No
F-16026AR Prosecution Diversion Agreement, Arabic DMS Arabic 05/2018 PDF No
F-16026CM Prosecution Diversion Agreement, Chinese (Simplified) DMS Chinese (Simplified) 05/2018 PDF No
F-16026G Prosecution Diversion Agreement, German DMS German 05/2018 PDF No
F-16026H Prosecution Diversion Agreement, Hmong DMS Hmong 05/2018 PDF No
F-16026L Prosecution Diversion Agreement, Laotian DMS Laotian 05/2018 PDF No
F-16026R Prosecution Diversion Agreement, Russian DMS Russian 05/2018 PDF No
F-16026SO Prosecution Diversion Agreement, Somali DMS Somali 05/2018 PDF No
F-16026S Prosecution Diversion Agreement, Spanish DMS Spanish 05/2018 PDF No
F-03326 Provider Agreement For Electronic (Email) Communications with Department of Health Services (DHS) Division of Quality Assurance (DQA) Feeding Assistant Program (FAP) DQA English 10/2024 PDF No
F-00917 Provider Enrollment Application Process DMS English 12/2013 HTML No
F-13607 Provider Participation Agreement - February 2008 OIG English 10/2008 HTML No
F-44725 Provider Supplement - Provider Participation Agreement DPH English 05/2019 Word No
F-01924 Public Comment on Rulemaking Project OLC English 03/2019 Word No
F-02250 Quarterly Program Integrity Report OIG English 05/2023 Excel No
F-02465 Radon Annual Report DPH English 10/2023 HTML No
F-02592 Rapid Test and Controls Inventory Log DPH English 01/2020 PDF No
F-02593 Rapid Testing Log DPH English 02/2022 PDF No
F-02591 Rapid Testing Temperature Log DPH English 01/2020 PDF No
F-02110 RCAC: Applicant Compliance Statement DQA English 04/2021 Word No
F-02110B RCAC: Established Provider Certification or Registration Application Checklist DQA English 08/2022 Word No
F-02110D RCAC: New Provider Certification or Registration Application Checklist DQA English 08/2022 Word No
F-01474 Receipt for Confiscated eWIC Cards DPH English 03/2015 Word No
F-00165A Recipient Contact Information OLC English 12/2021 Word No
F-45019 Reciprocity Privileges Checklist DPH English 04/2018 PDF No
F-11067 Record of Actual Daily Oxygen Use DMS English 07/2012 PDF No
F-11067 Record of Actual Daily Oxygen Use DMS English 07/2012 Word No
F-11067A Record of Actual Daily Oxygen Use: Completion Instructions DMS English 07/2012 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.

Glossary

 
Last revised December 4, 2024