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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.

Assigned Number Title Division Language Release Date File Type Available to Order
F-44024A Wisconsin WIC Referral/Request for Medical Food: Pregnant, Breastfeeding, and Non-breastfeeding Postpartum DPH English 05/2025 Word No
F-44024D Wisconsin WIC Referral/Request for Medical Formula/Food: Infants and Children DPH English 05/2025 Word No
F-02324 Wisconsin’s American Sign Language Interpreter, SSP and CART Directory Sign-Up and/or Change Request DPH English 10/2019 Word No
F-01578 Wisconsin’s Self-Directed IT System (WISITS) - Request For User Setup DMS English 10/2018 Word No
F-01223 WISEWOMAN Case Management DPH English 01/2025 Word No
F-01218 WISEWOMAN Client Consent DPH English 06/2024 Word No
F-01218S WISEWOMAN Client Consent, Spanish DPH Spanish 06/2024 Word No
F-01398 WISEWOMAN Client Home Blood Pressure Monitoring Agreement DPH English 10/2014 Word No
F-01398S WISEWOMAN Client Home Blood Pressure Monitoring Agreement, Spanish DPH Spanish 10/2014 Word No
F-01222 WISEWOMAN Diagnostic and Hypertension Management Referral DPH English 06/2024 Word No
F-01228 WISEWOMAN Follow-up Assessment: LSP/HC Complete DPH English 11/2019 Word No
F-01219 WISEWOMAN Health History Assessment DPH English 09/2024 Word No
F-01219S WISEWOMAN Health History Assessment, Spanish DPH Spanish 09/2024 Word No
F-01225 WISEWOMAN Healthy Behavior Encounter DPH English 09/2024 Word No
F-01220 WISEWOMAN Healthy Lifestyle Assessment DPH English 03/2019 Word No
F-01220S WISEWOMAN Healthy Lifestyle Assessment, Spanish DPH Spanish 03/2019 Word No
F-01219 WISEWOMAN Integrated Office Visit Assessment Packet DPH English 09/2024 Word No
F-01219 WISEWOMAN Integrated Office Visit Assessment Packet, Spanish DPH Spanish 09/2024 Word No
F-01421 WISEWOMAN Monthly Reporting for Direct Services DPH English 06/2024 Excel No
F-01229 WISEWOMAN Provider Assurances and Training Checklist DPH English 03/2019 Word No
F-01221 WISEWOMAN Screening Activity DPH English 09/2024 Word No
F-03291 WISEWOMAN Social Services and Support Assessment DPH English 09/2024 Word No
F-03291S WISEWOMAN Social Services and Support Assessment, Spanish DPH Spanish 09/2024 Word No
F-03125 WisTech Data Reporting for WisTech Partners DMS English 02/2023 HTML No
F-03105A WisTech Device Exchange Reporting DPH English 11/2022 HTML No
F-03105 WisTech Supplemental Quarterly Reporting DPH English 11/2022 HTML No
F-02966 Women, Infants, and Children (WIC) Appointment Experience Survey DPH English 02/2022 HTML No
F-02966S Women, Infants, and Children (WIC) Appointment Experience Survey DPH Spanish 02/2022 HTML No
F-40076 Women, Infants, and Children (WIC) Nutrition Program Employer Statement DPH English 08/2023 PDF No
F-40076S Women, Infants, and Children (WIC) Nutrition Program Employer Statement, Spanish DPH Spanish 08/2023 PDF No
F-02730 Worker COVID-19 Symptoms Screening DPH English 10/2020 Excel No
F-02729 Workplace Plan -Contact Tracing Planning Checklist DPH English 10/2020 Excel No
F-05108 Worksheet for Creating Your Child's Birth Record DPH English 09/2022 HTML No
F-05108S Worksheet for Creating Your Child's Birth Record, Spanish DPH Spanish 09/2022 HTML No
F-01337 Worksheet for Determination of Parental Payment Limit for CLTS and CCOP Programs DMS English 04/2025 Excel No
F-01337B Worksheet for Determination of Parental Payment Limit for CLTS and CCOP Programs, FAQs DMS English 09/2023 PDF No
F-01337A Worksheet for Determination of Parental Payment Limit for CLTS and CCOP Programs, Instructions DMS English 09/2022 PDF No
F-05109 Worksheet for Reporting Medical Information DPH English 05/2021 PDF No
F-05109H Worksheet for Reporting Medical Information, Hmong DPH Hmong 05/2021 PDF No
F-01170 Written Correspondence Inquiry DMS English 07/2012 Word No
F-01170 Written Correspondence Inquiry DMS English 07/2012 PDF No
F-00315 Written Prior Notice DMS English 03/2017 Word No
F-00315 Written Prior Notice DMS English 03/2017 PDF No
F-00315D Written Prior Notice - Additional Assessment Recommended DMS English 03/2017 PDF No
F-00315D Written Prior Notice - Additional Assessment Recommended DMS English 03/2017 Word No
F-00315D Written Prior Notice - Additional Assessment Recommended, Spanish DMS Spanish 03/2017 PDF No
F-00315A Written Prior Notice - No Evaluation Recommended DMS English 02/2017 Word No
F-00315A Written Prior Notice - No Evaluation Recommended DMS English 02/2017 PDF No
F-00315A Written Prior Notice - No Evaluation Recommended, Spanish DMS Spanish 02/2017 PDF No
F-00315S Written Prior Notice, Spanish DMS Spanish 03/2017 PDF No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

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Last revised December 4, 2024