Skip to main content

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-00236SO Request for a State Fair Hearing, Somali DMS Somali 02/2020 PDF No
F-00236S Request for a State Fair Hearing, Spanish DMS Spanish 02/2020 PDF No
F-00236S Request for a State Fair Hearing, Spanish DMS Spanish 02/2020 Word No
F-01134 Request for a Waiver to Wisconsin Medicaid Prescription Requirements Under the School-Based Services Benefit DMS English 09/2019 PDF No
F-01134 Request for a Waiver to Wisconsin Medicaid Prescription Requirements Under the School-Based Services Benefit DMS English 09/2019 Word No
F-00944 Request for Approval: Comprehensive Community Services (CCS) Regional Service Model DCTS English 09/2016 Word No
F-02595 Request for Approval: Youth Crisis Stabilization Facilities (YCSF) Certification Application DCTS English 10/2020 Word No
F-02733 Request for Community Spouse Signature DMS English 06/2023 PDF No
F-02733H Request for Community Spouse Signature, Hmong DMS Hmong 06/2023 PDF No
F-02733S Request for Community Spouse Signature, Spanish DMS Spanish 06/2023 PDF No
F-20691 Request for Exemption - Intoxicated Driver Program (IDP), Employment of Individuals with Lesser Qualifications DCTS English 10/2016 PDF No
F-20691 Request for Exemption - Intoxicated Driver Program (IDP), Employment of Individuals with Lesser Qualifications DCTS English 10/2016 Word No
F-02925 Request for HIV Care Grievance Resolution DPH English 01/2022 Word No
F-01885 Request for ImageTrend Patient Registry Access DPH English 07/2023 PDF No
F-03191 Request for ImageTrend Patient Registry Access for Additional Facilities DPH English 07/2023 PDF No
F-25527 Request for Increased Contract Allocation DCTS English 01/2017 Word No
F-02885 Request for Institution of Mental Disease Determination for Children’s Residential Settings DMS English 10/2021 Word No
F-02885 Request for Institution of Mental Disease Determination for Children’s Residential Settings DMS English 10/2021 PDF No
F-02746 Request for Institution of Mental Disease Determination for Residential Substance Use Disorder Facilities DMS English 12/2020 Word No
F-02746 Request for Institution of Mental Disease Determination for Residential Substance Use Disorder Facilities DMS English 12/2020 PDF No
F-20448 Request for Medicaid Administrative Funds - Staff Position DMS English 03/2017 Word No
F-02937 Request for Medicaid Coverage Consideration for Procedures and Devices DMS English 02/2022 HTML No
F-01020A Request for Nursing Home Care Determination Completion Instructions DMS English 02/2017 PDF No
F-62457 Request for Permission to Start Construction for Footings and Foundations DQA English 01/2021 Word No
F-62457 Request for Permission to Start Construction for Footings and Foundations DQA English 01/2021 PDF No
F-00330 Request for Replacement FoodShare and/or Summer EBT Benefits DMS English 10/2024 PDF No
F-00330AR Request for Replacement FoodShare and/or Summer EBT Benefits, Arabic DMS Arabic 10/2024 PDF No
F-00330CM Request for Replacement FoodShare and/or Summer EBT Benefits, Chinese (Simplified) DMS Chinese (Simplified) 10/2024 PDF No
F-00330G Request for Replacement FoodShare and/or Summer EBT Benefits, German DMS German 10/2024 PDF No
F-00330H Request for Replacement FoodShare and/or Summer EBT Benefits, Hmong DMS Hmong 10/2024 PDF No
F-00330L Request for Replacement FoodShare and/or Summer EBT Benefits, Laotian DMS Laotian 10/2024 PDF No
F-00330R Request for Replacement FoodShare and/or Summer EBT Benefits, Russian DMS Russian 10/2024 PDF No
F-00330SO Request for Replacement FoodShare and/or Summer EBT Benefits, Somali DMS Somali 10/2024 PDF No
F-00330S Request for Replacement FoodShare and/or Summer EBT Benefits, Spanish DMS Spanish 10/2024 PDF No
F-20572 Request for State Public Funding for Non-Residents DCTS English 05/2020 Word No
F-62608 Request for Use of Medical Restraints DMS English 03/2017 Word No
F-62608 Request for Use of Medical Restraints DMS English 03/2017 PDF No
F-00926A Request for Use of Medical Restraints - CLTSS DMS English 02/2017 PDF No
F-00926A Request for Use of Medical Restraints - CLTSS DMS English 02/2017 Word No
F-62607 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan DMS English 03/2017 Word No
F-62607 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan DMS English 03/2017 PDF No
F-00569 Request for Waiver of Administrative Rule for Licensure DPH English 09/2019 Word No
F-03282 Request for Waiver of Administrative Rule—Trauma Care Services DPH English 06/2024 PDF No
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS English 07/2012 PDF No
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS English 07/2012 Word No
F-00054A Request for Waiver of Requirements Relating to Co-Location of an ADRC and ICA/MCO or ADRC and Staff Subcontracted to an ICA/MCO DPH English 07/2016 Word No
F-00054B Request for Waiver of Requirements Relating to Organizational Separation when MCO Care Management is Subcontracted to the Same Agency Responsible for ADRC DPH English 07/2016 Word No
F-22539 Request for Waiver of State SSI or Caretaker Supplement Overpayment Recovery or Change in Repayment Rate DMS English 06/2015 PDF No
F-00054D Request for Waiver of the 0.5 Full-Time Equivalent Requirement for ADRC Staff DPH English 07/2016 Word No
F-02068 Request to Establish a Children's COP Risk Reserve DMS English 04/2017 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.

Glossary

 
Last revised December 4, 2024