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-04020LPT Student Immunization Record, Long, Portuguese DPH Portuguese 05/2024 PDF No
F-04020LPU Student Immunization Record, Long, Punjabi DPH Punjabi 05/2024 PDF No
F-04020LSO Student Immunization Record, Long, Somali DPH Somali 05/2024 PDF No
F-04020LS Student Immunization Record, Long, Spanish DPH Spanish 05/2024 PDF No
F-00659 Substance Abuse Block Grant Prevention Program / Practice Approval DCTS English 09/2018 Word No
F-21088 Substance Abuse Prevention Services Information System (SAP-SIS) Agency / User Web Access Request DCTS English 11/2016 Word No
F-22567 Substance Abuse Prevention Treatment Block Grant Annual Reporting DCTS English 02/2023 HTML No
F-01601A Summary Line Item Budget - 20% Match DCTS English 12/2024 Excel No
F-01601E Summary Line Item Budget - 25% Match Required DCTS English 12/2024 Excel No
F-00989B Summary of Development (IFSP) DMS English 02/2017 Word No
F-00989BS Summary of Development (IFSP), Spanish DMS Spanish 02/2017 Word No
F-00989E Summary of Development - Child’s Independence and Ability to Meet Own Needs (IFSP) DMS English 02/2017 Word No
F-00989ES Summary of Development - Child’s Independence and Ability to Meet Own Needs (IFSP), Spanish DMS Spanish 02/2017 Word No
F-00989C Summary of Development Child’s Positive Social Emotional Skills (IFSP) DMS English 02/2017 Word No
F-00989CS Summary of Development Child’s Positive Social Emotional Skills (IFSP), Spanish DMS Spanish 02/2017 Word No
F-00989D Summary of Development Child’s Use of Knowledge and Skills (IFSP) DMS English 02/2017 Word No
F-00989DS Summary of Development Child’s Use of Knowledge and Skills (IFSP), Spanish DMS Spanish 02/2017 Word No
F-00098 Summary of Information Letter DMS English 06/2019 PDF No
F-00989L Summary of Services (IFSP) DMS English 02/2017 Word No
F-00989LS Summary of Services (IFSP), Spanish DMS Spanish 02/2017 Word No
F-02620 Supervised Release (SR) Client Contact Request DCTS English 02/2020 Word No
F-02616 Supervised Release (SR) Client Vehicle Purchase Request DCTS English 02/2020 Word No
F-02616S Supervised Release (SR) Client Vehicle Purchase Request, Spanish DCTS Spanish 02/2020 Word No
F-02661 Supervised Release Client Work/Education Request DCTS English 05/2020 Word No
F-02522 Supervised Release Individual Client Summary DCTS English 10/2021 Word No
F-25615 Supervised Release Rules, English DCTS English 01/2017 Word No
F-25615S Supervised Release Rules, Spanish DCTS Spanish 01/2017 Word No
F-01305 Supplemental Security Income-Related Determination DMS English 03/2017 PDF No
F-02435 Support and Service Coordinator Waiver Basics Training Requirement Attestation DMS English 12/2018 Word No
F-02377 Supported Decision-Making Agreement DPH English 08/2018 Word No
F-02377 Supported Decision-Making Agreement DPH English 08/2018 PDF No
F-02377AR Supported Decision-Making Agreement, Arabic DPH Arabic 08/2018 PDF No
F-02377S Supported Decision-Making Agreement, Spanish DPH Spanish 08/2018 Word No
F-02377S Supported Decision-Making Agreement, Spanish DPH Spanish 08/2018 PDF No
F-02384 Syndromic Surveillance Data Use Application DPH English 12/2023 PDF No
F-47463F Tactical EMS Service Provider Operational Plan Components Checklist DPH English 09/2022 Word No
F-40063 TEFAP / CSFP Commodities Complaint DPH English 04/2023 Word No
F-40062 TEFAP / CSFP Commodity Loss Report DPH English 07/2004 Word No
F-00989G Tell Us About Your Family (IFSP) DMS English 02/2017 Word No
F-00989GS Tell Us About Your Family (IFSP), Spanish DMS Spanish 02/2017 Word No
F-02257 Temperature Excursion Incident Report - Wisconsin Immunization Program DPH English 02/2024 Word No
F-02619 Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials DMS English 02/2021 Word No
F-02619AR Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Arabic DMS Arabic 02/2021 Word No
F-02619CM Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Chinese (Simplified) DMS Chinese (Simplified) 02/2021 Word No
F-02619H Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Hmong DMS Hmong 02/2021 Word No
F-02619L Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Laotian DMS Laotian 02/2021 Word No
F-02619SE Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Serbo-Croatian DMS Serbian (Serbo-Croatian) 02/2021 Word No
F-02619SO Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Somali DMS Somali 02/2021 Word No
F-02619S Template Language Managed Care Organizations are Required to Use in Grievance and Appeal Materials, Spanish DMS Spanish 02/2021 Word No
F-10119 Temporary Enrollment for Family Planning Only Services DMS English 02/2024 PDF Yes

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