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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-02973A Trauma Care Facility Classification Review Committee Application DPH English 02/2022 Word No
F-00602C Trauma Care Facility Classification Review Committee: Focused Visit Action Plan Report DPH English 01/2023 Word No
F-00602 Trauma Care Facility Final Report DPH English 10/2024 Word No
F-00602A Trauma Care Facility In-Person Focused Visit Final Report DPH English 01/2023 Word No
F-00602B Trauma Care Facility Paperwork Submission Focused Visit Cover Sheet DPH English 01/2023 Word No
F-00602D Trauma Care Facility Quality Review Report DPH English 02/2023 Word No
F-02872 Trauma Care Facility Site Reviewer Performance Assessment DPH English 09/2021 HTML No
F-80190 Travel Reimbursement Request Non-State Employee DES English 09/2024 PDF No
F-80190 Travel Reimbursement Request Non-State Employee DES English 09/2024 Excel No
F-03093A Tribal ADRS Customer Service Agreement DPH English 09/2022 PDF No
F-02057A Tribal ADRS Program Authorization for the Release of Confidential Information DPH English 05/2022 Word No
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH English 08/2019 Excel No
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH English 06/2022 Word No
F-03104 Tribal Aging and Disability Resource Specialist Annual Update Checklist DPH English 11/2022 Word No
F-03104 Tribal Aging and Disability Resource Specialist Annual Update Checklist DPH English 11/2022 HTML No
F-11130 Tribal and Out-of-State Federally Qualified Health Center DMS English 01/2021 Excel No
F-11129A Tribal and Out-of-State Federally Qualified Health Center Cost Report Completion Instructions DMS English 01/2021 PDF No
F-11129 Tribal and Out-of-State Federally Qualified Health Center Cost Report Forms OIG English 01/2021 Excel No
F-11130A Tribal and Out-of-State Federally Qualified Health Center, Instructions DMS English 01/2021 PDF No
F-02462 Tuberculosis (TB) Treatment Assistance Enrollment and Agreement DPH English 10/2019 PDF No
F-02463 Tuberculosis (TB) Treatment Assistance Program - Request for Reimbursement DPH English 01/2021 PDF No
F-02461 Tuberculosis (TB) Treatment Assistance Program - Special Request DPH English 10/2020 PDF No
F-00905A Tuberculosis Contact Window Treatment Initial Request for Medication DPH English 09/2021 PDF No
F-44000 Tuberculosis Disease Initial Request for Medication DPH English 11/2023 PDF No
F-00905 Tuberculosis Infection - Initial Request for Medication DPH English 06/2024 Word No
F-02163 Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement DPH English 06/2019 PDF No
F-42001 Tuberculosis Suspect Case Data DPH English 04/2001 PDF No
F-00634A Types and Locations of Early Intervention Records Birth to 3 Program DMS English 02/2017 Word No
F-00727 Typical Hearing Developmental Milestones DMS English 02/2017 Word No
F-10189 Undue Hardship Bed Hold Notice DMS English 04/2017 Word No
F-10188 Undue Hardship Waiver Decision for Facility DMS English 04/2017 Word No
F-03135 Update to an EMS Service Providers Operational Plan Components Checklist DPH English 03/2023 Word No
F-02140 Urgent Services Agreement DPH English 02/2024 Word No
F-02140 Urgent Services Agreement (DocuSign) DPH English 02/2024 HTML No
F-02140LP Urgent Services Agreement (Large Print) DPH English 02/2024 Word No
F-02140AR Urgent Services Agreement, Arabic DPH Arabic 02/2024 PDF No
F-02140CM Urgent Services Agreement, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word No
F-02140H Urgent Services Agreement, Hmong DPH Hmong 02/2024 Word No
F-02140L Urgent Services Agreement, Laotian DPH Laotian 02/2024 Word No
F-02140R Urgent Services Agreement, Russian DPH Russian 02/2024 Word No
F-02140SE Urgent Services Agreement, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word No
F-02140SO Urgent Services Agreement, Somali DPH Somali 02/2024 Word No
F-02140S Urgent Services Agreement, Spanish DPH Spanish 02/2024 Word No
F-00044 User Agreement for System Access DES English 01/2017 Word No
F-02995 Vaccination Community Outreach Grant Quarterly Report DPH English 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 10/2010 PDF No
F-44702S Vaccine Administration Record, Spanish DPH Spanish 10/2010 PDF No
F-03196 Vaccine Borrowing Report DPH English 04/2024 PDF No
F-02502 Vaccine for Adults (VFA) Community Outreach DPH English 04/2022 PDF No
F-02495 Vaccine for Adults (VFA) Provider Agreement DPH English 09/2024 PDF No

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Last revised August 26, 2024