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Data Collection (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 form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-01068E General Pediatric Clinic - 9 Month Visit DMS English 08/2019 PDF No
F-01068E General Pediatric Clinic - 9 Month Visit DMS English 08/2019 Word No
F-01068K General Pediatric Clinic - Elementary School Visit DMS English 08/2019 Word No
F-01068K General Pediatric Clinic - Elementary School Visit DMS English 08/2019 PDF No
F-01068J General Pediatric Clinic - Preschool Visit DMS English 08/2019 PDF No
F-01068J General Pediatric Clinic - Preschool Visit DMS English 08/2019 Word No
F-01068L General Pediatric Clinic - Teenager Visit DMS English 08/2019 PDF No
F-01068L General Pediatric Clinic - Teenager Visit DMS English 08/2019 Word No
F-45021 Generally Licensed Device Inspection by Mail DPH English 03/2010 Word No
F-45021 Generally Licensed Device Inspection by Mail DPH English 03/2010 PDF No
F-10111 Good Faith Medicaid / BadgerCare Plus Certification DMS English 09/2013 PDF No
F-10111A Good Faith Medicaid / BadgerCare Plus Certification Instructions DMS English 09/2013 PDF No
F-02122 Grant Funding Request Opioid and Stimulant Unmet Needs DCTS English 08/2023 Word No
F-00642 Grants Enrollment, Application & Reporting System (GEARS) Expenditure Report DES English 11/2023 Excel No
F-01212 Grievance - IRIS Program DMS English 03/2024 Word No
F-01212FR Grievance - IRIS Program, French DMS French 03/2024 Word No
F-02726 Hand Hygiene (HH) and Personal Protective Equipment (PPE) Observations DPH English 10/2020 PDF No
F-02475 Hand Hygiene Observations DPH English 06/2021 PDF No
F-03227 Harm Reduction Response Team Outreach Efforts DPH English 09/2023 HTML No
F-02989 Hazard Assessment Section Presentation Feedback DPH English 03/2022 HTML No
F-02382 HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet DMS English 10/2018 Word No
F-02383 HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary DMS English 12/2020 Word No
F-02383C HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - 3-4 AFH DMS English 01/2021 Word No
F-02383A HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - CBRF DMS English 01/2021 Word No
F-02383B HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - RCAC DMS English 01/2021 Word No
F-02605A HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist DMS English 09/2022 Word No
F-02605AI HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist , Instructions DMS English 09/2022 PDF No
F-00004 Health and Employment Counseling Application DMS English 11/2023 PDF No
F-00004H Health and Employment Counseling Application, Hmong DMS Hmong 11/2023 PDF No
F-00004S Health and Employment Counseling Application, Spanish DMS Spanish 11/2023 PDF No
F-00004B Health and Employment Counseling Employment Report DMS English 11/2023 PDF No
F-00004BH Health and Employment Counseling Employment Report, Hmong DMS Hmong 11/2023 PDF No
F-00004BS Health and Employment Counseling Employment Report, Spanish DMS Spanish 11/2023 PDF No
F-00004A Health and Employment Counseling Extension Request DMS English 11/2023 PDF No
F-00004AH Health and Employment Counseling Extension Request, Hmong DMS Hmong 11/2023 PDF No
F-00004AS Health and Employment Counseling Extension Request, Spanish DMS Spanish 11/2023 PDF No
F-43006 Health Care Employer Assurance for J-1 Visa Waiver Applications DPH English 10/2018 PDF No
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 Word No
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 PDF No
F-62500 Health Care Facility Fire Report DQA English 10/2018 HTML No
F-03276 Health Information Exchange Patient Choice DCTS English 03/2024 PDF No
F-01062 HealthCheck Adolescent Review DMS English 08/2019 Word No
F-01062 HealthCheck Adolescent Review DMS English 08/2019 PDF No
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 PDF No
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 Word No
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 Word No
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 PDF No
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 Word No
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 PDF No
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age DMS English 07/2008 Word No
Last revised December 8, 2023