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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-01104 Specialized Psychiatric Rehabilitation Services (SPRS) Monthly Roster DMS English 08/2023 Excel No
F-01306 Spousal Impoverishment Income Allocation Worksheet DMS English 07/2014 PDF No
F-20812 SSI-E Natural Residential Setting Application Checklist DMS English 09/2019 Word No
F-20812 SSI-E Natural Residential Setting Application Checklist DMS English 09/2019 PDF No
F-11055 STAT-PA System Instructions DMS English 07/2015 PDF No
F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request DMS English 04/2017 PDF No
F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request DMS English 04/2017 Word No
F-00030A State and Specialty Maximum Allowed Cost Drug Pricing Review Request: Completion Instructions DMS English 04/2017 PDF No
F-00100 State Vital Records Birth Certificate Request Letter DMS English 06/2019 Word No
F-02430 Statement About Immigration Status DMS English 03/2019 PDF No
F-02430DA Statement About Immigration Status, Dari DMS Dari (Afghan Persian) 03/2019 PDF No
F-02430H Statement About Immigration Status, Hmong DMS Hmong 03/2019 PDF No
F-02430PA Statement About Immigration Status, Pashto DMS Pashto 03/2019 PDF No
F-02430S Statement About Immigration Status, Spanish DMS Spanish 03/2019 PDF No
F-02431 Statement About U.S. Military Service DMS English 06/2023 PDF No
F-02431AR Statement About U.S. Military Service, Arabic DMS Arabic 06/2023 PDF No
F-02431BU Statement About U.S. Military Service, Burmese DMS Burmese 06/2023 PDF No
F-02431CM Statement About U.S. Military Service, Chinese (Simplified) DMS Chinese (Simplified) 06/2023 PDF No
F-02431G Statement About U.S. Military Service, German DMS German 06/2023 PDF No
F-02431H Statement About U.S. Military Service, Hmong DMS Hmong 06/2023 PDF No
F-02431L Statement About U.S. Military Service, Laotian DMS Laotian 06/2023 PDF No
F-02431R Statement About U.S. Military Service, Russian DMS Russian 06/2023 PDF No
F-02431SO Statement About U.S. Military Service, Somali DMS Somali 06/2023 PDF No
F-02431S Statement About U.S. Military Service, Spanish DMS Spanish 06/2023 PDF No
F-10161 Statement of Citizenship and/or Identity DMS English 07/2018 PDF No
F-10154 Statement of Identity for Children Under 18 Years of Age DMS English 07/2008 PDF No
F-10154DA Statement of Identity for Children Under 18 Years of Age, Dari DMS Dari (Afghan Persian) 07/2008 PDF No
F-10154H Statement of Identity for Children Under 18 Years of Age, Hmong DMS Hmong 07/2008 PDF No
F-10154PA Statement of Identity for Children Under 18 Years of Age, Pashto DMS Pashto 07/2008 PDF No
F-10154R Statement of Identity for Children Under 18 Years of Age, Russian DMS Russian 07/2008 PDF No
F-10154S Statement of Identity for Children Under 18 Years of Age, Spanish DMS Spanish 07/2008 PDF No
F-10175 Statement of Identity for Persons in Institutional Care Facilities DMS English 06/2023 PDF No
F-25177 Statement of Probable Cause and Detention and Petition for Revocation DCTS English 03/2021 Word No
F-25177 Statement of Probable Cause and Detention and Petition for Revocation DCTS English 03/2021 PDF No
F-00685 Statement of Tribal Affiliation DMS English 06/2023 PDF No
F-01809 Statewide Naloxone Signup (RedCap) DPH English 08/2016 HTML No
F-01802 Statewide Naloxone Standing Order for Pharmacist, Sample DPH English 07/2023 PDF No
F-02967 Statewide Trauma Advisory Council (STAC) Agenda Request DPH English 02/2022 HTML No
F-02973 Statewide Trauma Advisory Council: Advisory Board Team Member Application DPH English 02/2022 Word No
F-20935 Status Report to Court for Plan Compliance DCTS English 03/2017 PDF No
F-01344 Strategies for Success with People Who Have Dementia-Behavior Analysis Worksheet-Model DPH English 09/2016 PDF No
F-16023 Striker Evaluation DMS English 07/2008 PDF No
F-16031 Student Aid and Expense Worksheet DMS English 07/2008 PDF No
F-16021 Student Financial Aid Report DMS English 07/2008 PDF No
F-04020 Student Immunization Record - This form is intended for schools DPH English 02/2008 PDF Yes
F-04020L Student Immunization Record, Long DPH English 05/2024 PDF No
F-04020LAR Student Immunization Record, Long, Arabic DPH Arabic 05/2024 PDF No
F-04020LCM Student Immunization Record, Long, Chinese (Simplified) DPH Chinese (Simplified) 05/2024 PDF No
F-04020LHI Student Immunization Record, Long, Hindi DPH Hindi 05/2024 PDF No
F-04020LH Student Immunization Record, Long, Hmong DPH Hmong 05/2024 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