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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 Sort descending Division Language Release Date File Type Available to Order
F-01442G IRIS Program Disenrollment Letter - Non-Spending DMS English 01/2022 Word
F-01442K IRIS Program Disenrollment Letter - Policy Noncompliance DMS English 01/2022 PDF
F-01442H IRIS Program Disenrollment Letter - Voluntary DMS English 01/2022 Word
F-01314 IRIS Program Employment Checklist DMS English 02/2017 Word
F-01556A IRIS Program First Delinquent Medicaid Cost Share Payment Letter DMS English 01/2021 Word
F-02432 IRIS Program HIPAA Breach and Unauthorized Disclosure Reporting DMS English 10/2022 Word
F-01556D IRIS Program Letter - Disenrollment DMS English 01/2022 Word
F-01204F IRIS Program Notice of Action Letter - Denied Provider Change DMS English 07/2022 Word
F-01309 IRIS Program Orientation and Enrollment Checklist DMS English 04/2019 Word
F-01556BB IRIS Program Previous Delinquent Medicaid Cost Share Payment Letter DMS English 01/2021 Word
F-01556B IRIS Program Second Delinquency Medicaid Cost Share Payment Letter DMS English 01/2021 Word
F-01454G IRIS Program Withdrawal Letter - Cancelled DMS English 01/2022 Word
F-01454H IRIS Program Withdrawal Letter - Conflict of Withdrawal DMS English 01/2022 Word
F-01454F IRIS Program Withdrawal Letter - Death DMS English 01/2022 Word
F-01454A IRIS Program Withdrawal Letter - Financial or Functional Eligibility DMS English 01/2022 Word
F-01454B IRIS Program Withdrawal Letter - Health and Safety DMS English 01/2022 Word
F-01454C IRIS Program Withdrawal Letter - No Contact DMS English 01/2022 Word
F-01454 IRIS Program Withdrawal Letter - No Progress DMS English 01/2022 Word
F-01454D IRIS Program Withdrawal Letter - Non Eligible Setting DMS English 01/2022 Word
F-01454E IRIS Program Withdrawal Letter - Voluntary DMS English 01/2022 Word
F-01312 IRIS Provider Application DMS English 12/2022 Word
F-01203 IRIS Provider Education - Health and Safety - Incident Reporting DMS English 02/2017 Word
F-01566 IRIS Self-Directed Personal Care (SDPC) - My Cares DMS English 02/2020 Word
F-01258 IRIS Self-Directed Personal Care (SDPC) Disclosure Statement DMS English 06/2019 Word
F-01258 IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, French DMS French 06/2019 Word
F-01258 IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, Spanish DMS Spanish 06/2019 Word
F-01319D IRIS Self-Directed Personal Care (SDPC) Involuntary Disenrollment Request DMS English 02/2017 Word
F-01578A IRIS SharePoint - Request for User Setup DMS English 09/2022 Word
F-01601B ISP Line Item Detail Budget DCTS English 09/2016 Excel
F-00989M Justification for Services Provided in Locations Other than Natural Environments (IFSP) DMS English 02/2017 Word
F-00989M Justification for Services Provided in Locations Other than Natural Environments (IFSP), Spanish DMS Spanish 02/2017 Word
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 PDF
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 Word
F-03096 Katie Beckett Release of Information DMS English 02/2023 Word
F-03096 Katie Beckett Release of Information DMS English 02/2023 PDF
F-03096 Katie Beckett Release of Information, Instructions DMS English 02/2023 PDF
F-03096 Katie Beckett Release of Information: Clinic Specific DMS English 02/2023 Word
F-03096 Katie Beckett Release of Information: Clinic Specific DMS English 02/2023 PDF
F-62501 Laboratory Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 07/2016 Word
F-62501 Laboratory Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 07/2016 PDF
F-02265 Latent Tuberculosis Infection (LTBI) Confidential Case Report DPH English 05/2019 PDF
F-44125 Latent Tuberculosis Infection (LTBI) Follow-Up Report DPH English 01/2019 PDF
F-44063 Lead (Pb) Principal Instructor Application DPH English 07/2021 PDF
F-44012 Lead Abatement Notification DPH English 11/2017 PDF
F-00171 Lead Company Certification Application DPH English 07/2021 PDF
F-00171 Lead Company Certification Application, Spanish DPH Spanish 07/2021 PDF
F-01320 Lead Test Kit Documentation DPH English 08/2014 Word
F-44062 Lead Training Manager Application DPH English 07/2021 PDF
F-44013 Lead-Based Paint (LBP) Investigation Summary Report DPH English 06/2021 PDF
F-44003 Lead-Safe Renovator Application DPH English 07/2021 PDF
Last revised January 23, 2023