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Use the list below to identify the form number and title for your order. If you do not find the form you are looking for, it may be available only in electronic format. Review the lists available in the left border of this page to find all electronic forms. View the list of publications available from the forms/publications center.

Key word explanations for Form Type and Other Location columns.

Division Prefix / Old Form Number Assigned Form Number Form Title Form Type Other Location Language
DLTC F-00315 Written Prior Notice - Birth to 3 (PDF, 14 KB) PDF Form Center English
DLTC F-00315 Written Prior Notice - Birth to 3 Word Form Center English
DLTC F-00780 Options Counseling Tip Card Paper Form Center English
DLTC F-00888 Next Steps (PDF, 89 KB) Paper Form Center English
HCF-01112 F-01112 HealthCheck Verification Card Paper Form Center English
DPH-04020 F-04020 Student Immunization Record - This form is intended for Schools Paper Form Center English
DPH-04020L F-04020L Student Immunization Record, Long (PDF, 303 KB) PDF Form Center English
DPH-04020LH F-04020LH Student Immunization Record, Long - Hmong (PDF, 84 KB) PDF Form Center Hmong
DPH-04020LS F-04020LS Student Immunization Record, Long - Spanish (PDF, 50 KB) PDF Form Center Spanish
DPH-05021 F-05021 Report of Legal Name Change Paper Form Center English
DPH-05103 F-05103 Facts About Your Child's Birth Certificate Paper Form Center English
DPH-05104 F-05103S Facts About Your Child's Birth Certificate - Spanish Paper Form Center Spanish
DPH-05191 F-05191 Vital Records Fee Schedule--Now numbered P-05191 Paper Form Center English
HCF-10075 F-10075 Wisconsin Well Woman Medicaid Determination (PDF, 78 KB) Paper Form Center English
HCF-10076 F-10076 SeniorCare Application (PDF, 179 KB) Paper Form Center English
HCF-10076A F-10076A SeniorCare Instructions for Application Form (PDF, 71 KB) Paper Form Center English
HCF-10081 F-10081 BadgerCare Plus Express Enrollment for Pregnant Women Application Paper Form Center English
HCF-10101 F-10101 Wisconsin Medicaid for the Elderly, Blind or Disabled Application Packet (PDF, 532 KB) Paper Form Center English
HCF-10112 F-10112 Medicaid Disability Application (PDF, 1982 KB) Paper Form Center English
HCF-10119 F-10119 Temporary Enrollment For Family Planning Only Services Paper Form Center English
HCF-10137 F-10137 Medicaid Change Report (PDF, 88 KB) Paper Form Center English
HCF-10182 F-10182 BadgerCare Plus Application Packet (PDF, 1192 KB) Paper Form Center English
HCF-10183 F-10183 BadgerCare Plus Change Report (PDF, 345 KB) Paper Form Center English
HCF-13038 F-13038 Notice of Intent to File a Lien Paper Form Center English
HCF-16006 F-16006 FoodShare Wisconsin Change Report (PDF, 250 KB) Paper Form Center English
HCF-16019A F-16019A FoodShare Wisconsin Registration / Important Information (PDF, 112 KB) Paper Form Center English
HCF-16019B F-16019B FoodShare Wisconsin Application / Registration (PDF, 756 KB) Paper Form Center English
HCF-16066 F-16066 FoodShare Wisconsin Income Change Report (PDF, 171 KB) Paper Form Center English
HCF-16104 F-16104 Local Agency Customer Feedback (PDF, 17 KB) Paper Form Center English
HCF-16104S F-16104S Local Agency Customer Feedback - Spanish (PDF, 16 KB) Paper Form Center Spanish
DES F-20468 HSRS FSP Module and Expenditures Paper Form Center English
DES F-20468 HSRS FSP Module and Expenditures Word Form Center English
DDE-0823 F-20823 COP Functional Screen (PDF, 134 KB) PDF Form Center English
DDE-2018 F-22018 HSRS Long-Term Support Module (PDF, 51 KB) PDF Form Center English
DDE-2018 F-22018 HSRS Long-Term Support Module Word Form Center English
DDE-5311 F-25311 Notification to Victims of Offenders Paper Form Center English
DDE-5534 F-25534 Notification to Victims of Sexually Violent Persons Paper Form Center English
DPH-40028R F-40028R CSFP Ineligibility, Termination, and Waiting List - Russian Paper Form Center Russian
DPH-40028S F-40028S CSFP Ineligibility, Termination, and Waiting List - Spanish Paper Form Center Spanish
DPH-40040 F-40040 Envelope - No. 9 Vendor and Integrity Unit Address Paper Form Center English
DPH-40041 F-40041 CSFP Certification & Food Package Pick-Up For Seniors (PDF, 21 KB) PDF Form Center English
DPH-40041H F-40041H CSFP Certification & Food Package Pick-Up For Seniors - Hmong (PDF, 22 KB) PDF Form Center Hmong
DPH-40041R F-40041R CSFP Certification & Food Package Pick-Up For Seniors - Russian (PDF, 156 KB) PDF Form Center Russian
DPH-40041S F-40041S CSFP Certification & Food Package Pick-Up For Seniors - Spanish (PDF, 156 KB) PDF Form Center Spanish
DPH-40044H F-40044H CSFP Rights and Responsibilities - Hmong Paper Form Center Hmong
DPH-40044R F-40044R CSFP Rights and Responsibilities - Russian Paper Form Center Russian
DPH-40044S F-40044S CSFP Rights and Responsibilities - Spanish Paper Form Center Spanish
DPH-40076 F-40076 WIC Income Statement (PDF, 85 KB) PDF Form Center English
DPH-40076S F-40076S WIC Income Statement - Spanish (PDF, 103 KB) PDF Form Center Spanish
DPH-40103 F-40103 FMNP Senior Eligibility Agreement (PDF, 104 KB) Paper Form Center English
DPH-40103H F-40103H FMNP Senior Eligibility Agreement - Hmong (PDF, 141 KB) Paper Form Center English
DPH-40103S F-40103S FMNP Senior Eligibility Agreement - Spanish (PDF, 143 KB) Paper Form Center English
DPH-40123A F-40123A Hearing Screening Postcard - English Paper Form Center English
DPH-40123AH F-40123AH Hearing Screening Postcard - Hmong Paper Form Center English
DPH-40123AS F-40123AS Hearing Screening Postcard - Spanish Paper Form Center English
DPH-43016 F-43016 Prevent Heart Disease & Stroke Wallet Card Paper Form Center English
DPH-04089 F-44089 Wisconsin WIC Checks Accepted Here - Stickers Paper Form Center English
DPH-04151 F-44151 Acute and Communicable Disease Case Report (PDF, 149 KB) PDF Form Center English
DPH-04151 F-44151 Acute and Communicable Disease Case Report Word Form Center English
DPH-04158 F-44158 WIC Application Brochure/Postcard Paper Form Center English
DPH-04158H F-44158H WIC Application Brochure/Postcard - Spanish Paper Form Center Hmong
DPH-04158S F-44158S WIC Application Brochure/Postcard - Spanish Paper Form Center Spanish
DPH-04160A F-44160A WIC Plastic Cover for WIC ID Folder Paper Form Center English
DPH-04160L F-44160L WIC ID Folder Paper Form Center English
DPH-04160LS F-44160LS WIC ID Folder - Spanish Paper Form Center Spanish
DPH-04161 F-44161 WIC Rights and Responsibilities (PDF, 35 KB) PDF Form Center English
DPH-04161H F-44161H WIC Rights and Responsibilities - Hmong (PDF, 30 KB) PDF Form Center Hmong
DPH-04161S F-44161S WIC Rights and Responsibilities - Spanish (PDF, 42 KB) PDF Form Center Spanish
DPH-04192 F-44192 Day Care Immunization Record (PDF, 553 KB) PDF Form Center English
DPH-04243 F-44243 Sexually Transmitted Diseases Laboratory & Morbidity Epidemiologic Case Report Word Form Center English
DPH-04257 F-44257 Wisconsin Immunization Record Card Paper Form Center English
DPH-04292 F-44292 VIP Immunization Record 6 X 4 Paper Form Center English
DPH-04702 F-44702 Vaccine Administration Record (PDF, 41 KB) PDF Form Center English
DPH-04702S F-44702S Vaccine Administration Record - Spanish (PDF, 46 KB) PDF Form Center Spanish
DPH-04727 F-44727 WIC Vendor Training Proof Paper Form Center English
DPH-04750 F-44750 Inspection Report - Supplement (PDF, 38 KB) PDF Form Center English
DPH 4756 F-44756 Wisconsin Tuberculosis Record Card Paper FormsCenter English
DPH 4756H F-44756H Wisconsin Tuberculosis Record Card - Hmong Paper FormsCenter Hmong
DPH 4756S F-44756S Wisconsin Tuberculosis Record Card - Spanish Paper FormsCenter Spanish
DPH-04828 F-44828 Make Your Smile Count - Oral Screening Paper Form Center English
DPH-45002A F-45002A Restaurant/Retail Food Service Inspection Report Paper Form Center English
DPH-45002B F-45002B Restaurant/Retail Food Service Inspection Report Page 2 Paper Form Center English
DPH-45002C F-45002C Restaurant/Retail Food Service Inspection Report Page 3 Paper Form Center English
DPH-45004 F-45004 Temporary Restaurant Inspection Report Paper Form Center English
DPH-45029 F-45029 School Food Safety Program Inspection Report Paper Form Center English
DPH-45029I F-45029i Instructions For School Food Safety Plan Paper Form Center English
DPH-45030 F-45030 Inspection Narrative Paper Form Center English
DPH-45031 F-45031 Waterslide Inspection Report Paper Form Center English
DPH-07018 F-47018 State of Wisconsin Permit Application to Operate a Mobile Restaurant / Mobile Service Base Word Form Center English
DPH-07205 F-47205 Swimming Pool Inspection Report (PDF, 929 KB) PDF Form Center English
DPH-07206 F-47206 Campground Inspection Report Paper Form Center English
DPH-07208 F-47208 Recreational / Educaional Camp Inspection Report Paper Form Center English
DPH-07208A F-47208A Additional Page for Recreational Sanitation Paper Form Center English
DPH-07217 F-47217 Bed and Breakfast Inspection Report (PDF, 22 KB) PDF Form Center English
DPH-07454 F-47454 Tattoo and Body Piercing Inspection Report (PDF, 2.9 MB) PDF Form Center English
DPH-09357 F-49357 Personal Diabetes Care Record (PDF, 152 KB) PDF Form Center English
DPH-09357S F-49357S Personal Diabetes Care Record - Spanish (PDF, 102 KB) PDF Form Center Spanish
OQA-9259 F-69259 Long Term Care Facility Application For Medicare and Medicaid CMS-671 Paper Form Center English
OQA-9260 F-69260 Resident Census and Conditions of Residents CMS-672 Paper Form Center English
OQA-9261 F-69261 Extended / Partial Extended Survey Worksheet CMS-673 Paper Form Center English
CMS-677 F-69265 Medication Administration Observation CMS-20056 Paper Form Center English
OQA-9305 F-69305 Roster / Sample Matrix CMS-802 Paper Form Center English
OQA-9306 F-69306 General Observations of The Facility CMS-803 Paper Form Center English
OQA-9307 F-69307 Kitchen / Food Service Observation HCFA-804 Paper Form Center English
OQA-9308 F-69308 Resident Review Worksheet CMS-805 Paper Form Center English
OQA-9309 F-69309 Quality of Life Assessment - Resident Interview CMS-806A Paper Form Center English
OQA-9310 F-69310 Quality of Life Assessment - Group Interview CMS-806B Paper Form Center English
OQA-9311 F-69311 Quality of Life Assessment - Family Interview CMS-806C Paper Form Center English
OQA-9312 F-69312 Surveyor Notes Worksheet CMS-807 Paper Form Center English
DMT-0025 F-80025 Forms / Publications Requisition Paper Form Center English
DMT-0188 F-80188 Check Distribution / Attachments Word Form Center English
HFS-0009II F-82009II WIC Confidential Information Release Authorization (PDF, 52 KB) PDF Form Center English
HFS-0009IIH F-82009IIH WIC Confidential Information Release Authorization - Hmong (PDF, 26 KB) PDF Form Center Hmong
HFS-0009IIS F-82009IIS WIC Confidential Information Release Authorization - Spanish (PDF, 94 KB) PDF Form Center Spanish
HFS-0018C F-82018C Work Time Absence Record - 2014 Excel - Fillable Form Center English
HFS-0018C F-82018C Work Time Absence Record - 2014 (PDF, 791 KB) PDF Form Center English
HFS-0064 F-82064 Background Information Disclosure (BID) and Instructions (PDF, 52 KB) Paper Form Center English
HFS-0064 F-82064 Background Information Disclosure (BID) Word Form Center English
HFS-0064 F-82064A Background Information Disclosure (BID) Instructions only (PDF, 27 KB) Paper Form Center English