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-00840 Pharmacy Services Lock-In Program - HMO Responsibilities for Member Referral to Pharmacy Services Lock-In Program DMS English 02/2025 PDF
F-00840 Pharmacy Services Lock-In Program - HMO Responsibilities for Member Referral to Pharmacy Services Lock-In Program DMS English 02/2025 Word
F-00842 Pharmacy Services Lock-In Program - Program Summary DMS English 07/2013 PDF
F-11183 Pharmacy Services Lock-In Program / Designation of Alternate Prescriber for Restricted Medications Services DMS English 02/2025 Word
F-11183 Pharmacy Services Lock-In Program / Designation of Alternate Prescriber for Restricted Medications Services DMS English 02/2025 PDF
F-00345 Pharmacy Services Lock-In Program HMO Designation of Prescriber for Restricted Medication Services DMS English 02/2025 PDF
F-00345 Pharmacy Services Lock-In Program HMO Designation of Prescriber for Restricted Medication Services DMS English 02/2025 Word
F-00406 Pharmacy Services Lock-In Program HMO Member Designation of Pharmacy DMS English 02/2025 Word
F-00406 Pharmacy Services Lock-In Program HMO Member Designation of Pharmacy DMS English 02/2025 PDF
F-11184 Pharmacy Services Lock-In Program Member Designation of Providers DMS English 02/2025 Word
F-11184 Pharmacy Services Lock-In Program Member Designation of Providers DMS English 02/2025 PDF
F-00250 Pharmacy Services Lock-In Program Request for Review of Member Prescription Drug Use DMS English 02/2025 PDF
F-00250 Pharmacy Services Lock-In Program Request for Review of Member Prescription Drug Use DMS English 02/2025 Word
F-13074 Pharmacy Special Handling Request DMS English 04/2014 Word
F-13074 Pharmacy Special Handling Request DMS English 04/2014 PDF
F-13074A Pharmacy Special Handling Request: Completion Instructions DMS English 07/2012 PDF
F-00614 Physician, Physician Assistant, and Registered Nurse Equivalency Application DPH English 09/2019 Word
F-62333 Plan Approval Application DQA English 08/2024 Word
F-20934A Plan Recommendation DCTS English 03/2017 PDF
F-20934A Plan Recommendation, Spanish DCTS Spanish 03/2017 PDF
F-62590 Post Onsite Review Questionnaire - Nurse Aide Training Programs DQA English 07/2008 PDF
F-62590 Post Onsite Review Questionnaire - Nurse Aide Training Programs DQA English 07/2008 Word
F-01413 Post-Assessment Questionnaire DPH English 03/2016 Word
F-00036 Power of Attorney for Finance and Property DPH English 09/2010 HTML
F-00603 PPS (Program Participation System) Core Module DES English 04/2012 Word
F-00588 PPS Alcohol and Other Drug Abuse Module DCTS English 06/2019 Word
F-00588A PPS AODA Deskcard DCTS English 02/2019 PDF
F-00603A PPS Core Deskcard DES English 04/2013 PDF
F-00596A PPS Mental Health Deskcard DCTS English 07/2018 PDF
F-00596 PPS Mental Health Module DCTS English 06/2019 Word
F-01412 Pre-Assessment Questionnaire DPH English 03/2016 Word
F-02237 Pre-Hire Driving Record Review DES English 01/2022 Word
F-03359 Pre-Registration - DQA Misconduct Reporting System DQA English 02/2025 HTML
F-02702 Pre-Release Enrollment Agreement DPH English 02/2024 Word
F-02702 Pre-Release Enrollment Agreement (DocuSign) DPH English 02/2024 HTML
F-01341 Pre-Release from Institution Checklist (CM Checklist) DCTS English 09/2016 Word
F-01332 Predispositional Investigation Report (PDI) DCTS English 09/2016 Word
F-00401 Preferred Drug List (PDL) Expedited Emergency Supply Request DMS English 01/2021 Word
F-00401 Preferred Drug List (PDL) Expedited Emergency Supply Request DMS English 01/2021 PDF
F-00401A Preferred Drug List (PDL) Expedited Emergency Supply Request, Instructions DMS English 01/2021 PDF
F-03185 Prenatal Care Coordination Care Coordinator Visit Checklist DMS English 06/2023 PDF
F-03185 Prenatal Care Coordination Care Coordinator Visit Checklist DMS English 06/2023 Word
F-03183 Prenatal Care Coordination Care Plan DMS English 06/2023 PDF
F-03183 Prenatal Care Coordination Care Plan DMS English 06/2023 Word
F-03183A Prenatal Care Coordination Care Plan, Instructions DMS English 06/2023 PDF
F-03186 Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring DMS English 12/2023 PDF
F-03186 Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring DMS English 12/2023 Word
F-03186A Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring, Instructions DMS English 12/2023 PDF
F-03188 Prenatal Care Coordination Plan of Operation DMS English 06/2023 PDF
F-03188 Prenatal Care Coordination Plan of Operation DMS English 06/2023 Word

Glossary

 
Last revised December 4, 2024