F-44013 |
Lead-Based Paint (LBP) Investigation Summary Report |
DPH |
English |
06/2021 |
PDF |
No |
F-44003 |
Lead-Safe Renovator Application |
DPH |
English |
11/2023 |
PDF |
No |
F-44003S |
Lead-Safe Renovator Application, Spanish |
DPH |
Spanish |
11/2023 |
PDF |
No |
F-44001AR |
Legal Notice: Required Immunizations (Shots) for Admission to Wisconsin Schools, Arabic |
DPH |
Arabic |
06/2024 |
PDF |
No |
F-44001HI |
Legal Notice: Required Immunizations (Shots) for Admission to Wisconsin Schools, Hindi |
DPH |
Hindi |
06/2024 |
PDF |
No |
F-44001PU |
Legal Notice: Required Immunizations (Shots) for Admission to Wisconsin Schools, Punjabi |
DPH |
Punjabi |
06/2024 |
PDF |
No |
F-44001A |
Legal Notice: Required Immunizations for Admission to Wisconsin Child Care Centers |
DPH |
English |
12/2017 |
PDF |
No |
F-44001AS |
Legal Notice: Required Immunizations for Admission to Wisconsin Child Care Centers, Spanish |
DPH |
Spanish |
12/2017 |
PDF |
No |
F-44001 |
Legal Notice: Required Immunizations for Admission to Wisconsin Schools |
DPH |
English |
06/2024 |
PDF |
No |
F-44001CM |
Legal Notice: Required Immunizations for Admission to Wisconsin Schools, Chinese Mandarin |
DPH |
Chinese Mandarin |
06/2024 |
PDF |
No |
F-44001H |
Legal Notice: Required Immunizations for Admission to Wisconsin Schools, Hmong |
DPH |
Hmong |
06/2024 |
PDF |
No |
F-44001SO |
Legal Notice: Required Immunizations for Admission to Wisconsin Schools, Somali |
DPH |
Somali |
06/2024 |
PDF |
No |
F-44001S |
Legal Notice: Required Immunizations for Admission to Wisconsin Schools, Spanish |
DPH |
Spanish |
06/2024 |
PDF |
No |
F-01661 |
Letter - Foster Care Termination, Family |
DMS |
English |
07/2023 |
Word |
No |
F-01661A |
Letter - Foster Care Termination, Youth |
DMS |
English |
11/2023 |
Word |
No |
F-05260 |
Letter of Non-Marriage Application |
DPH |
English |
05/2024 |
PDF |
No |
F-05260S |
Letter of Non-Marriage Application - Spanish |
DPH |
Spanish |
05/2024 |
PDF |
No |
F-01567A |
Letter: Request for Assignment of Medical Benefits |
DMS |
English |
01/2021 |
Word |
No |
F-02876 |
Letter: Screen Visit Not Scheduled |
DMS |
English |
09/2021 |
Word |
No |
F-02876H |
Letter: Screen Visit Not Scheduled, Hmong |
DMS |
Hmong |
09/2021 |
Word |
No |
F-02876S |
Letter: Screen Visit Not Scheduled, Spanish |
DMS |
Spanish |
09/2021 |
Word |
No |
F-02874 |
Letter: Screen Visit Scheduled |
DMS |
English |
09/2021 |
Word |
No |
F-02874H |
Letter: Screen Visit Scheduled, Hmong |
DMS |
Hmong |
09/2021 |
Word |
No |
F-02874S |
Letter: Screen Visit Scheduled, Spanish |
DMS |
Spanish |
09/2021 |
Word |
No |
F-02663 |
Letterhead - EVV Personal Identification Number (PIN) |
DMS |
English |
02/2021 |
HTML |
No |
F-47484 |
Level III Pre-Review Questionnaire (PRQ) |
DPH |
English |
07/2023 |
Word |
No |
F-47484A |
Level IV Pre-Review Questionnaire (PRQ) |
DPH |
English |
07/2023 |
Word |
No |
F-62019 |
License Application for Nursing Home, Intermediate Care Facility - Individuals with Intellectual Disabilities (ICF-IID), or Institute for Mental Disease (IMD) |
DQA |
English |
12/2014 |
Word |
No |
F-01022 |
License Application Nursing Home, Facility for Developmentally Disabled, Institute for Mental Disease |
DMS |
English |
02/2017 |
Excel |
No |
F-00165E |
Limited English Proficiency (LEP) Customer Data Analysis Chart |
OLC |
English |
12/2021 |
Word |
No |
F-02731 |
Line List: Respiratory Virus Outbreak - Workplace Environment |
DPH |
English |
10/2020 |
Excel |
No |
F-16104 |
Local Agency Customer Feedback |
DMS |
English |
10/2017 |
PDF |
Yes |
F-16104H |
Local Agency Customer Feedback, Hmong |
DMS |
Hmong |
10/2017 |
PDF |
No |
F-16104S |
Local Agency Customer Feedback, Spanish |
DMS |
Spanish |
10/2017 |
PDF |
Yes |
F-03036 |
Local and Tribal Health Department (LTHD) Antigen Test Distribution Program Participation Attestation |
DPH |
English |
05/2022 |
PDF |
No |
F-01802A |
Local Prescriber Naloxone Standing Order for Pharmacists template |
DPH |
English |
12/2019 |
Word |
No |
F-01573 |
Log of Ice Arena Air Quality |
DPH |
English |
06/2015 |
Word |
No |
F-62595 |
Long-Term Care Facility Feeding Assistant Roster |
DQA |
English |
06/2024 |
Word |
No |
F-01567 |
Long-Term Care Insurance Policy - Assignment of Benefits |
DMS |
English |
12/2018 |
Word |
No |
F-01567 |
Long-Term Care Insurance Policy - Assignment of Benefits |
DMS |
English |
12/2018 |
PDF |
No |
F-01567S |
Long-Term Care Insurance Policy - Assignment of Benefits, Spanish |
DMS |
Spanish |
12/2018 |
PDF |
No |
F-03069 |
LTHD COVID-19 Antigen Test Distribution Program |
DPH |
English |
04/2023 |
HTML |
No |
F-02188 |
Lyme Disease Case Worksheet |
DPH |
English |
02/2022 |
PDF |
No |
F-12022 |
Managed Care Program Provider Appeal |
DMS |
English |
02/2020 |
Word |
No |
F-12022 |
Managed Care Program Provider Appeal |
DMS |
English |
02/2020 |
PDF |
No |
F-12022A |
Managed Care Program Provider Appeal Instructions |
DMS |
English |
02/2020 |
PDF |
No |
F-02946 |
Management Evaluation Review (MER) Advocate Survey |
DMS |
English |
02/2024 |
HTML |
No |
F-02945 |
Management Evaluation Review (MER) Income Maintenance (IM) Staff Survey |
DMS |
English |
02/2024 |
HTML |
No |
F-00777 |
MAPT Vendor Related Allocation Formula |
DMS |
English |
02/2017 |
Word |
No |
F-01915 |
Marketplace or Indicator Gap Filling Eligibility Determinations Supplemental Letter |
DMS |
English |
07/2017 |
Word |
No |