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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-01189 Instructions DMS English 02/2020 PDF No
F-11136 Instructions DMS English 10/2008 PDF No
F-02382 Instructions DMS English 10/2020 PDF No
F-00286 Instructions DMS English 07/2015 PDF No
F-00556 Instructions DMS English 01/2018 PDF No
F-11040 Instructions DMS English 12/2019 PDF No
F-01188 Instructions DMS English 02/2020 PDF No
F-00162 Instructions DMS English 05/2020 PDF No
F-80112 Instructions DES English 06/2008 PDF No
F-00232 Instructions DMS English 12/2021 PDF No
F-01187 Instructions DMS English 02/2018 PDF No
F-00202 Instructions (PDF, 177 KB) DCTS English 08/2016 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint OLC English 08/2018 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint, Hmong OLC Hmong 08/2018 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint, Spanish OLC Spanish 08/2018 PDF No
F-00989i Instructions for Completing Wisconsin's Individualized Family Service Plan (IFSP) DMS English 03/2017 PDF No
F-03112 Instructions for Logging HMO Appeals DMS English 12/2022 PDF No
F-02466 Instructions for Logging MCO Appeals DMS English 12/2022 PDF No
F-02466A Instructions for Logging MCO Grievances DMS English 12/2022 PDF No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 Word No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 PDF No
F-45029i Instructions For School Food Safety Plan DPH English 04/2006 Paper Yes
F-00539 Instructions for the County Waiver Agency Support and Service Coordination (SSC) Rates DMS English 09/2019 PDF No
F-44623 Instructions for WIC Time Study and Non-WIC Time Study DPH English 06/2020 PDF No
F-20582 Instructions, English DMS English 03/2023 PDF No
F-20582 Instructions, Hmong DMS Hmong 03/2023 PDF No
F-00107 Instructions, Self-Employment Income Report DMS English 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Chinese Mandarin DMS Chinese Mandarin 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Hmong DMS Hmong 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Spanish DMS Spanish 06/2019 PDF No
F-20582 Instructions, Spanish DMS Spanish 03/2023 PDF No
F-01721 Instructions-Calculating CLTS Foster Care Room and Board Expenses DMS English 03/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records DMS English 02/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish DMS Spanish 02/2017 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 02/2022 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong DMS Hmong 02/2022 PDF No
F-02717 Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish DMS Spanish 02/2022 PDF No
F-01234 Instructions: Explanation of Medical Benefits DMS English 04/2018 PDF No
F-16030 Instructions: FoodShare Wisconsin Overpayment Calculator DMS English 01/2018 PDF No
F-22540 Instructions: Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs OPIB English 05/2019 PDF No
F-10110 Instructions: Medicaid/BadgerCare Plus Eligibility Certification DMS English 01/2018 HTML No
F-02074 Instructions: Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF No
F-11133 Instructions: Personal Care Screening Tool (PCST) DMS English 08/2017 PDF No
F-11010 Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2018 PDF No
F-11008 Instructions: Prior Authorization / Therapy Attachment (PA/TA) DMS English 05/2019 PDF No
F-01248 Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF No
F-01012 Instructions: Reimbursement Request for a PASRR Level I Screen DMS English 08/2017 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business DMS English 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Chinese Mandarin DMS Chinese Mandarin 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Hmong DMS Hmong 06/2019 PDF No
Last revised January 23, 2023