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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-02140AR Urgent Services Agreement, Arabic DPH Arabic 02/2024 PDF No
F-02140CM Urgent Services Agreement, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word No
F-02140H Urgent Services Agreement, Hmong DPH Hmong 02/2024 Word No
F-02140L Urgent Services Agreement, Laotian DPH Laotian 02/2024 Word No
F-02140R Urgent Services Agreement, Russian DPH Russian 02/2024 Word No
F-02140SE Urgent Services Agreement, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word No
F-02140SO Urgent Services Agreement, Somali DPH Somali 02/2024 Word No
F-02140S Urgent Services Agreement, Spanish DPH Spanish 02/2024 Word No
F-00044 User Agreement for System Access DES English 01/2017 Word No
F-02995 Vaccination Community Outreach Grant Quarterly Report DPH English 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 10/2010 PDF No
F-44702S Vaccine Administration Record, Spanish DPH Spanish 10/2010 PDF No
F-03196 Vaccine Borrowing Report DPH English 04/2024 PDF No
F-02502 Vaccine for Adults (VFA) Community Outreach DPH English 04/2022 PDF No
F-02495 Vaccine for Adults (VFA) Provider Agreement DPH English 09/2024 PDF No
F-02503 Vaccine for Outbreak Response Request DPH English 08/2019 PDF No
F-01744 Vaccine Restitution Policy - Agreement DPH English 12/2023 PDF No
F-02287 Vaccine Return - Request for Authorization to Return DPH English 12/2017 PDF No
F-21059 Variance Request for Institution Respite DMS English 03/2017 Word No
F-21059 Variance Request for Institution Respite DMS English 03/2017 PDF No
F-44322 Vendor / Participant Complaint - Wisconsin Women, Infant, and Children (WIC) Program DPH English 03/2018 PDF No
F-04003 Vendor Monitoring Site Visit Report Wisconsin: WIC Program DPH English 10/2021 PDF No
F-02919 Vendor Performance Report for Division of Medicaid Services (DMS) DMS English 01/2024 Word No
F-02622 Vendor/Participant Complaint: Wisconsin WIC and Senior Farmers' Market Nutrition Program (FMNP) DPH English 03/2023 Word No
F-01017 Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement DMS English 08/2019 Word No
F-01017 Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement DMS English 08/2019 PDF No
F-01017A Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement Completion Instructions DMS English 07/2008 PDF No
F-10162 Verification of Veterans Benefits DMS English 12/2022 PDF No
F-02193 Verifying Tax-Exempt Income for Live-In Care Providers DMS English 06/2023 PDF No
F-05283 Veteran's and Veteran's Dependent's Request for Certified Copy of a Wisconsin Vital Record DPH English 10/2017 PDF Yes
F-02329 VFC Change of Information DPH English 05/2023 PDF No
F-03273 Victim Notification Request DCTS English 08/2024 HTML No
F-01394 Virginia Graeme Baker Act - Drain Cover Replacement Log DPH English 12/2014 PDF No
F-02520 Voluntarily Declining Benefits DMS English 01/2023 PDF No
F-00335 Voluntary Agreement for Crisis Stabilization Services DCTS English 02/2024 Word No
F-05024 Voluntary Paternity Acknowledgement DPH English 05/2016 Paper Only Yes
F-05024S Voluntary Paternity Acknowledgement, Spanish DPH Spanish 05/2016 Paper Only Yes
F-02410 Voluntary Property Checklist for Child Care Providers DPH English, Hmong, Spanish 04/2024 HTML No
F-02410 Voluntary Property Checklist for Child Care Providers DPH English 04/2024 PDF No
F-02410H Voluntary Property Checklist for Child Care Providers, Hmong DPH Hmong 04/2024 PDF No
F-02410S Voluntary Property Checklist for Child Care Providers, Spanish DPH Spanish 04/2024 PDF No
F-02879 Vulnerable/High Risk Determination - IRIS Program DMS English 09/2021 Word No
F-16039 Waiver of Administrative Disqualification Hearing DMS English 07/2023 PDF No
F-16039AR Waiver of Administrative Disqualification Hearing, Arabic DMS Arabic 07/2023 PDF No
F-16039CM Waiver of Administrative Disqualification Hearing, Chinese (Simplified) DMS Chinese (Simplified) 07/2023 PDF No
F-16039G Waiver of Administrative Disqualification Hearing, German DMS German 05/2018 PDF No
F-16039H Waiver of Administrative Disqualification Hearing, Hmong DMS Hmong 07/2023 PDF No
F-16039KU Waiver of Administrative Disqualification Hearing, Kurdish DMS Kurdish 05/2018 PDF No
F-16039L Waiver of Administrative Disqualification Hearing, Laotian DMS Laotian 05/2018 PDF No
F-16039R Waiver of Administrative Disqualification Hearing, Russian DMS Russian 07/2023 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.

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Last revised December 4, 2024