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 Sort descending Division Language Release Date File Type Available to Order
F-01598 Medical Exemption from Work Requirement for Able-Bodied Adults Without Dependents DMS English 08/2015 PDF
F-01598H Medical Exemption from Work Requirement for Able-Bodied Adults Without Dependents, Hmong DMS Hmong 08/2015 PDF
F-01598S Medical Exemption from Work Requirement for Able-Bodied Adults Without Dependents, Spanish DMS Spanish 08/2015 PDF
F-01586 Medical Stockpile Access Request DPH English 03/2020 PDF
F-01618 Medicare Counseling Client Services Agreement DPH English 04/2022 HTML
F-01618 Medicare Counseling Client Services Agreement DPH English 04/2022 Word
F-01618A Medicare Counseling Client Services Agreement, Instructions DPH English 04/2022 PDF
F-01618LP Medicare Counseling Client Services Agreement, Large Print DPH English 04/2022 Word
F-01618S Medicare Counseling Client Services Agreement, Spanish DPH Spanish 04/2022 Word
F-02074 Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF
F-02074 Medicare Other Coverage Discrepancy Report DMS English 04/2018 Word
F-00855 Medication Therapy Management Case Management Software Requirements DMS English 08/2014 PDF
F-00855A Medication Therapy Management Case Management Software Vendor Steps for Software Approval Process DMS English 08/2013 PDF
F-13026 Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums DMS English 05/2024 PDF
F-13026S Member / Employer Electronic Funds Transfer for BadgerCare Plus Premiums, Spanish DMS Spanish 05/2024 PDF
F-01915A Member Request Gap Filling Eligibility Determinations Supplemental Letter DMS English 07/2017 Word
F-13023 Member/Employer Electronic Funds Transfer for Medicaid Purchase Plan Premiums DMS English 03/2025 PDF
F-03313 Mental Health and Substance Use Changes to Provider Information DQA English 12/2024 Word
F-11090 Mental Health Day Treatment Functional Assessment DMS English 08/2015 Word
F-11090 Mental Health Day Treatment Functional Assessment DMS English 08/2015 PDF
F-11090A Mental Health Day Treatment Functional Assessment: Completion Instructions DMS English 08/2015 PDF
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA English 11/2011 PDF
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA English 11/2011 Word
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA English 12/2011 Word
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA English 12/2011 PDF
F-00380 Mental Health or Substance Use Treatment Provider Closing Certification DQA English 12/2024 Word
F-01389 MHSIP Adult Satisfaction Survey DCTS English 08/2022 PDF
F-01389H MHSIP Adult Satisfaction Survey, Hmong DCTS Hmong 08/2022 PDF
F-01389KH MHSIP Adult Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 08/2022 PDF
F-01389L MHSIP Adult Satisfaction Survey, Laotian DCTS Laotian 08/2022 PDF
F-01389NE MHSIP Adult Satisfaction Survey, Nepali DCTS Nepali 08/2022 PDF
F-01389SO MHSIP Adult Satisfaction Survey, Somali DCTS Somali 08/2022 PDF
F-01389S MHSIP Adult Satisfaction Survey, Spanish DCTS Spanish 08/2022 PDF
F-01389B MHSIP Family Satisfaction Survey DCTS English 09/2021 PDF
F-01389BH MHSIP Family Satisfaction Survey, Hmong DCTS Hmong 09/2021 PDF
F-01389BKH MHSIP Family Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 09/2021 PDF
F-01389BL MHSIP Family Satisfaction Survey, Laotian DCTS Laotian 09/2021 PDF
F-01389BNE MHSIP Family Satisfaction Survey, Nepali DCTS Nepali 09/2021 PDF
F-01389BSO MHSIP Family Satisfaction Survey, Somali DCTS Somali 09/2021 PDF
F-01389BS MHSIP Family Satisfaction Survey, Spanish DCTS Spanish 09/2021 PDF
F-01389A MHSIP Youth Satisfaction Survey DCTS English 09/2021 PDF
F-01389AH MHSIP Youth Satisfaction Survey, Hmong DCTS Hmong 09/2021 PDF
F-01389AKH MHSIP Youth Satisfaction Survey, Khmer (Cambodian) DCTS Khmer (Cambodian) 09/2021 PDF
F-01389AL MHSIP Youth Satisfaction Survey, Laotian DCTS Laotian 09/2021 PDF
F-01389ANE MHSIP Youth Satisfaction Survey, Nepali DCTS Nepali 09/2021 PDF
F-01389ASO MHSIP Youth Satisfaction Survey, Somali DCTS Somali 09/2021 PDF
F-01389AS MHSIP Youth Satisfaction Survey, Spanish DCTS Spanish 09/2021 PDF
F-03210 MI Team Survey DCTS English 08/2023 HTML
F-02258 Minority Health Advisory Committee Application DPH English 01/2018 Word
F-01930 Minority Health Advisory Group Nomination and Agreement DPH English 11/2016 Word

Glossary

 
Last revised December 4, 2024