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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-02110 RCAC: Applicant Compliance Statement DQA English 04/2021 Word No
F-02110B RCAC: Established Provider Certification or Registration Application Checklist DQA English 08/2022 Word No
F-02110D RCAC: New Provider Certification or Registration Application Checklist DQA English 08/2022 Word No
F-01474 Receipt for Confiscated eWIC Cards DPH English 03/2015 Word No
F-00165A Recipient Contact Information OLC English 12/2021 Word No
F-45019 Reciprocity Privileges Checklist DPH English 04/2018 PDF No
F-11067 Record of Actual Daily Oxygen Use DMS English 07/2012 PDF No
F-11067 Record of Actual Daily Oxygen Use DMS English 07/2012 Word No
F-11067A Record of Actual Daily Oxygen Use: Completion Instructions DMS English 07/2012 PDF No
F-02284 Record of School Employee Examination DPH English 02/2018 PDF No
F-00634B Records Access Log, Birth to 3 Program DMS English 07/2021 Word No
F-02706 Recovery Residence Registry Application DQA English 06/2024 Word No
F-02445 REDCap New Site Setup Request DPH English 01/2019 Word No
F-02445A REDCap User Access Setup Request DPH English 01/2025 Word No
F-00192 Referral / Communication Wisconsin WIC Program, English and Spanish DPH English, Spanish 08/2023 Word No
F-22469 Referral for Services from the Office for the Blind and Visually Impaired (OBVI) DPH English 08/2017 PDF No
F-00688 Referral to Wisconsin Birth to 3 Program DMS English 02/2024 PDF No
F-00688 Referral to Wisconsin Birth to 3 Program DMS English 02/2024 Word No
F-00688H Referral to Wisconsin Birth to 3 Program, Hmong DMS Hmong 02/2024 PDF No
F-00688H Referral to Wisconsin Birth to 3 Program, Hmong DMS Hmong 02/2024 Word No
F-00688S Referral to Wisconsin Birth to 3 Program, Spanish DMS Spanish 02/2024 PDF No
F-00688S Referral to Wisconsin Birth to 3 Program, Spanish DMS Spanish 02/2024 Word No
F-00771L Registers of Deeds and City Health Offices State Vital Records Office (SVRO) Forms Requisition DPH English 05/2021 PDF No
F-83263 Rehabilitation Review Application and Instructions OS English 09/2023 PDF No
F-02635 Release from Isolation Quarantine Calculator DPH English 01/2022 Excel No
F-02340 Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement DMS English 05/2023 PDF No
F-02340AR Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Arabic DMS Arabic 05/2023 PDF No
F-02340CM Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Chinese (Simplified) DMS Chinese (Simplified) 05/2023 PDF No
F-02340G Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, German DMS German 05/2023 PDF No
F-02340H Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Hmong DMS Hmong 05/2023 PDF No
F-02340L Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Laotian DMS Laotian 05/2023 PDF No
F-02340LP Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Large Print DMS English 05/2023 PDF No
F-02340R Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Russian DMS Russian 05/2023 PDF No
F-02340SO Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Somali DMS Somali 05/2023 PDF No
F-02340S Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Spanish DMS Spanish 05/2023 PDF No
F-02994 Remediation Survey for Child Care Centers DPH English 03/2022 HTML No
F-01989 Renewal Application - Individual Certification DPH English 03/2025 PDF No
F-01989S Renewal Application - Individual Certification, Spanish DPH Spanish 03/2025 PDF No
F-00233 Renewal Summary Letter DMS English 08/2019 Word No
F-00233H Renewal Summary Letter (Hmong) DMS Hmong 08/2019 Word No
F-00233S Renewal Summary Letter (Spanish) DMS Spanish 08/2019 Word No
F-02610D Rental Property - Lead-Safe Homes Program (LSHP) Application and Worksheet DPH English 12/2024 HTML No
F-02610A Rental Property - Lead-Safe Homes Program Application DPH English 03/2024 PDF No
F-02610AS Rental Property - Lead-Safe Homes Program Application, Spanish DPH Spanish 03/2024 PDF No
F-03193 Replacement Request For Stolen FoodShare Benefits OIG English 04/2024 PDF No
F-03193H Replacement Request For Stolen FoodShare Benefits, Hmong OIG Hmong 04/2024 PDF No
F-03193S Replacement Request For Stolen FoodShare Benefits, Spanish OIG Spanish 04/2024 PDF No
F-02642A Report a Change in Circumstance DMS English 08/2020 Word No
F-02642AH Report a Change in Circumstance, Hmong DMS Hmong 08/2020 Word No
F-02642AS Report a Change in Circumstance, Spanish DMS Spanish 08/2020 Word 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