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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-02432 IRIS Program HIPAA Breach and Unauthorized Disclosure Reporting DMS English 10/2022 Word No
F-01309 IRIS Program Orientation and Enrollment Checklist DMS English 04/2019 Word No
F-01312 IRIS Provider Application DMS English 12/2022 Word No
F-01203 IRIS Provider Education - Health and Safety - Incident Reporting DMS English 02/2017 Word No
F-03197 IRIS SDPC - Prior Authorization Notification - Transfer from MAPC to IRIS SDPC DMS English 07/2023 Word No
F-01566 IRIS Self-Directed Personal Care (SDPC) - My Cares DMS English 02/2020 Word No
F-01258 IRIS Self-Directed Personal Care (SDPC) Disclosure Statement DMS English 06/2019 Word No
F-01258FR IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, French DMS French 06/2019 Word No
F-01258S IRIS Self-Directed Personal Care (SDPC) Disclosure Statement, Spanish DMS Spanish 06/2019 Word No
F-01319D IRIS Self-Directed Personal Care (SDPC) Involuntary Disenrollment Request DMS English 02/2017 Word No
F-01578A IRIS SharePoint - Request for User Setup DMS English 06/2024 Word No
F-01601B ISP Line Item Detail Budget DCTS English 09/2016 Excel No
F-00989M Justification for Services Provided in Locations Other than Natural Environments (IFSP) DMS English 02/2017 Word No
F-00989MS Justification for Services Provided in Locations Other than Natural Environments (IFSP), Spanish DMS Spanish 02/2017 Word No
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 PDF No
F-03102 Katie Beckett Disability Evaluation Form DMS English 11/2022 Word No
F-03144 Katie Beckett Medicaid Medical Renewal: Provider Information DMS English 04/2023 Word No
F-03144H Katie Beckett Medicaid Medical Renewal: Provider Information, Hmong DMS Hmong 04/2023 Word No
F-03144S Katie Beckett Medicaid Medical Renewal: Provider Information, Spanish DMS Spanish 04/2023 Word No
F-03096 Katie Beckett Release of Information DMS English 05/2023 Word No
F-03096 Katie Beckett Release of Information DMS English 05/2023 PDF No
F-03096AH Katie Beckett Release of Information Instructions, Hmong DMS Hmong 02/2023 PDF No
F-03096AS Katie Beckett Release of Information Instructions, Spanish DMS Spanish 02/2023 PDF No
F-03096H Katie Beckett Release of Information, Hmong DMS Hmong 05/2023 PDF No
F-03096H Katie Beckett Release of Information, Hmong DMS Hmong 05/2023 Word No
F-03096A Katie Beckett Release of Information, Instructions DMS English 02/2023 PDF No
F-03096S Katie Beckett Release of Information, Spanish DMS Spanish 05/2023 PDF No
F-03096S Katie Beckett Release of Information, Spanish DMS Spanish 05/2023 Word No
F-03096B Katie Beckett Release of Information: Clinic Specific DMS English 05/2023 Word No
F-03096B Katie Beckett Release of Information: Clinic Specific DMS English 05/2023 PDF No
F-03096BH Katie Beckett Release of Information: Clinic Specific, Hmong DMS Hmong 05/2023 PDF No
F-03096BH Katie Beckett Release of Information: Clinic Specific, Hmong DMS Hmong 05/2023 Word No
F-03096BS Katie Beckett Release of Information: Clinic Specific, Spanish DMS Spanish 05/2023 PDF No
F-03096BS Katie Beckett Release of Information: Clinic Specific, Spanish DMS Spanish 05/2023 Word No
F-62501 Laboratory Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 07/2016 Word No
F-62501 Laboratory Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 07/2016 PDF No
F-02265 Latent Tuberculosis Infection (LTBI) Confidential Case Report DPH English 05/2019 PDF No
F-44125 Latent Tuberculosis Infection (LTBI) Follow-Up Report DPH English 01/2019 PDF No
F-44063 Lead (Pb) Principal Instructor Application DPH English 07/2021 PDF No
F-44012 Lead Abatement Notification DPH English 01/2024 PDF No
F-01313 Lead Certification Exam Reschedule Registration DPH English 04/2024 Word No
F-00171 Lead Company Certification Application DPH English 07/2021 PDF No
F-00171S Lead Company Certification Application, Spanish DPH Spanish 07/2021 PDF No
F-03281 Lead Course Registration Plan DPH English 05/2024 Word No
F-03281D Lead Course Test Policy and Score Report DPH English 05/2024 Word No
F-03281B Lead Quality Control Plan DPH English 05/2024 Word No
F-03281A Lead Recordkeeping Description DPH English 05/2024 Word No
F-01320 Lead Test Kit Documentation DPH English 08/2014 Word Yes
F-44062 Lead Training Manager Application DPH English 07/2021 PDF No
F-03281C Lead Training Resource Description DPH English 05/2024 Word No

Glossary

 
Last revised December 8, 2023