Official DHS 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 document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

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Language

Assigned Number	Title Sort descending	Division	Language	Release Date	File Type	Available to Order
F-03266	Request to Lower Your FoodShare Overpayment	DMS	English	02/2024	PDF	No
F-03266H	Request to Lower Your FoodShare Overpayment, Hmong	DMS	Hmong	02/2024	PDF	No
F-03266S	Request to Lower Your FoodShare Overpayment, Spanish	DMS	Spanish	02/2024	PDF	No
F-02603	Request to Not Pay Your Medicaid Purchase Plan Premium for a Short Time Because of a Difficult Situation	DMS	English	05/2024	PDF	No
F-02603H	Request to Not Pay Your Medicaid Purchase Plan Premium for a Short Time Because of a Difficult Situation, Hmong	DMS	Hmong	05/2024	PDF	No
F-02603S	Request to Not Pay Your Medicaid Purchase Plan Premium for a Short Time Because of a Difficult Situation, Spanish	DMS	Spanish	05/2024	PDF	No
F-19002	Request to Reduce QUEST Card Balance	DMS	English	08/2023	PDF	No
F-01845	Request to Remain on the Wisconsin HIV Drug Assistance Program (HDAP) and Decline Enrollment in Health Insurance	DPH	English	01/2025	PDF	No
F-01845S	Request to Remain on the Wisconsin HIV Drug Assistance Program (HDAP) and Decline Enrollment in Health Insurance, Spanish	DPH	Spanish	01/2025	PDF	No
F-00977	Research Data Use Agreement - Principal Investigator, Wisconsin Cancer Reporting System (WCRS)	DPH	English	05/2021	PDF	No
F-62373	Resident Evacuation Assessment	DQA	English	04/2009	Word	No
F-62373	Resident Evacuation Assessment	DQA	English	04/2009	PDF	No
F-02282A	Resident Relocation Plan	DMS	English	10/2023	Word	No
F-02282	Resident Relocation Roster	DMS	English	07/2018	Excel	No
F-02634C	Residential Care Apartment Complex (RCAC) Initial Survey Checklist	DQA	English	03/2020	Word	No
F-02766	Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members	DMS	English	06/2023	Word	No
F-02766	Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members	DMS	English	06/2023	PDF	No
F-03082E	Residential Substance Use Treatment Services (DHS 75.53, DHS 75.54, DHS 75.55, DHS 75.56, DHS 75.57, DHS 75.58) Initial Certification or Change of Ownership Application	DQA	English	02/2025	Word	No
F-03147	Resilient Wisconsin Help the Helper Training Evaluation	DCTS	English	04/2023	HTML	No
F-40108	Retail Vendor Application Amendment Wisconsin Women, Infant, and Children (WIC)	DPH	English	03/2024	PDF	No
F-01999A	Retired Senior Volunteer Program: State Match Funding Application	DPH	English	09/2019	Word	No
F-01800	Retroactive Overtime To Be Paid	DMS	English	01/2019	Word	No
F-21189	Rights of Detention	DCTS	English	05/2017	Word	No
F-21189S	Rights of Detention, Spanish	DCTS	Spanish	05/2017	Word	No
F-62601	Rights of Home Health Agency Patients	DQA	English	01/2025	PDF	No
F-62601S	Rights of Home Health Agency Patients, Spanish	DQA	Spanish	01/2025	PDF	No
F-01558	Risk Agreement - IRIS Program	DMS	English	09/2023	Word	No
F-00945	Risk Identification and Assessment Worksheet and Purchase of Service Audit Waiver Request	OS	English	11/2023	HTML	No
F-00945i	Risk Identification and Assessment Worksheet and Purchase of Service Audit Waiver Request Instructions	OS	English	11/2023	PDF	No
F-11025	Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs	DMS	English	04/2009	Word	No
F-11025	Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs	DMS	English	04/2009	PDF	No
F-11025A	Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs Instructions	DMS	English	04/2009	PDF	No
F-11026	Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs	DMS	English	04/2009	PDF	No
F-11026	Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs	DMS	English	04/2009	Word	No
F-11026A	Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs Completion Instructions	DMS	English	04/2014	PDF	No
F-11081	Rural Health Clinic Provider Staff Encounters	DMS	English	10/2016	Excel	No
F-11027	Rural Health Clinic Quarterly Cost Report	DMS	English	10/2016	Excel	No
F-11027A	Rural Health Clinic Quarterly Cost Report Completion Instructions	DMS	English	10/2016	PDF	No
F-11022	Rural Health Clinic Statistical Data	DMS	English	10/2016	PDF	No
F-11022	Rural Health Clinic Statistical Data	DMS	English	10/2016	Word	No
F-03081	Safe and Healthy Home Assessment	DPH	English	08/2022	PDF	No
F-03081	Safe and Healthy Home Assessment	DPH	English	12/2022	Excel	No
F-02828	School P-EBT Verification Letter Template	DMS	English	06/2021	Word	No
F-04002	School Report to Local Health Department, 2024-2025	DPH	English	07/2024	PDF	No
F-44212	School Report to the District Attorney	DPH	English	07/2016	PDF	No
F-02875	Self-Care Assessment	DPH	English	09/2021	Word	No
F-03303	Self-Directed Services HCBS Minimum Fee Rate Agreement	DMS	English	09/2024	PDF	No
F-00107	Self-Employment Income Report	DMS	English	06/2019	PDF	No
F-00107CM	Self-Employment Income Report, Chinese (Simplified)	DMS	Chinese (Simplified)	06/2019	PDF	No
F-00107H	Self-Employment Income Report, Hmong	DMS	Hmong	06/2019	PDF	No

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