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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-14014H Authorization to Disclose Information to Disability Determination Bureau (DDB), Hmong DMS Hmong 03/2022 PDF No
F-14014S Authorization to Disclose Information to Disability Determination Bureau (DDB), Spanish DMS Spanish 03/2022 PDF No
F-01829 Authorization to Receive and Disclose Information - AIDS/HIV Drug Assistance and Insurance Assistance Programs DPH English 09/2016 Word No
F-00048 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s) DPH English 08/2016 PDF No
F-00048S Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s), Spanish DPH Spanish 08/2016 PDF No
F-00101 Authorization to Request Birth Records DMS English 06/2019 Word No
F-02906 Authorization to Transfer Aging and Disability Services GPR Funding to Another Agency DPH English 09/2023 Word No
F-20987 Authorized Representative Designation Medicaid Community Waiver Programs DMS English 03/2017 PDF No
F-20987 Authorized Representative Designation Medicaid Community Waiver Programs DMS English 03/2017 Word No
F-20987S Authorized Representative Designation Medicaid Community Waiver Programs, Spanish DMS Spanish 03/2017 Word No
F-02118 Authorized Signer Designation for Access to PPS and FSIA DMS English 09/2022 PDF No
F-01352 Background Check Appeal Request - IRIS Program DMS English 02/2019 Word No
F-01352H Background Check Appeal Request - IRIS Program, Hmong DMS Hmong 02/2019 Word No
F-01352R Background Check Appeal Request - IRIS Program, Russian DMS Russian 02/2019 Word No
F-01352S Background Check Appeal Request - IRIS Program, Spanish DMS Spanish 02/2019 Word No
F-82064 Background Information Disclosure (BID) DQA English 01/2022 PDF No
F-82069 Background Information Disclosure (BID) Appendix for License Holders and Non Client Residents in DQA-Regulated Facilities DQA English 06/2018 Word No
F-82069A Background Information Disclosure (BID) Appendix Instructions DQA English 06/2018 PDF No
F-82064A Background Information Disclosure (BID) Instructions DQA English 01/2022 PDF No
F-82064AH Background Information Disclosure (BID) Instructions, Hmong DQA Hmong 01/2022 PDF No
F-82064AS Background Information Disclosure (BID) Instructions, Spanish DQA Spanish 01/2022 PDF No
F-82064H Background Information Disclosure (BID), Hmong DQA Hmong 01/2022 PDF No
F-82064S Background Information Disclosure (BID), Spanish DQA Spanish 01/2022 PDF No
F-03155 Background Information Disclosure Addendum - ILSP DPH English 07/2023 PDF No
F-03155H Background Information Disclosure Addendum - ILSP, Hmong DPH Hmong 07/2023 PDF No
F-03155LP Background Information Disclosure Addendum - ILSP, Large Print DPH English 07/2023 PDF No
F-03155SO Background Information Disclosure Addendum - ILSP, Somali DPH Somali 07/2023 PDF No
F-03155S Background Information Disclosure Addendum - ILSP, Spanish DPH Spanish 07/2023 PDF No
F-01246 Background Information Disclosure Addendum: IRIS DMS English 01/2024 Word No
F-01246H Background Information Disclosure Addendum: IRIS, Hmong DMS Hmong 01/2024 Word No
F-01246R Background Information Disclosure Addendum: IRIS, Russian DMS Russian 01/2024 Word No
F-01246S Background Information Disclosure Addendum: IRIS, Spanish DMS Spanish 01/2024 Word No
F-10081 BadgerCare Plus - Express Enrollment for Pregnant Women Application DMS English 02/2014 PDF Yes
F-10081A BadgerCare Plus - Express Enrollment for Pregnant Women Application Instructions DMS English 02/2024 PDF No
F-10115 BadgerCare Plus / Medicaid Health Insurance Information DMS English 01/2011 PDF No
F-10115S BadgerCare Plus / Medicaid Health Insurance Information, Spanish DMS Spanish 01/2011 PDF No
F-10182 BadgerCare Plus Application Packet DMS English 04/2024 PDF Yes
F-10182DA BadgerCare Plus Application Packet, Dari DMS Dari 04/2024 PDF No
F-10182H BadgerCare Plus Application Packet, Hmong DMS Hmong 04/2024 PDF No
F-10182PA BadgerCare Plus Application Packet, Pashto DMS Pashto 04/2024 PDF No
F-10182S BadgerCare Plus Application Packet, Spanish DMS Spanish 04/2024 PDF No
F-10185 BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication DMS English 09/2019 Word No
F-11309 BadgerCare Plus Express Enrollment for Children Provider Certification OIG English 01/2021 PDF No
F-11268 BadgerCare Plus Express Enrollment for Pregnant Women Provider Certification OIG English 01/2021 PDF No
F-10184 BadgerCare Plus Former Foster Care Youth (FFCY) DMS English 09/2019 Word No
F-13025 BadgerCare Plus Premium Employer Wage Withholding and Instructions DMS English 09/2013 PDF No
F-10139 BadgerCare Plus Premium Information / Payment DMS English 03/2018 PDF No
F-10139S BadgerCare Plus Premium Information / Payment (Spanish) DMS Spanish 03/2018 PDF No
F-13026 BadgerCare Plus Premium Member / Employer Electronic Funds Transfer and Instructions DMS English 05/2014 PDF No
F-13026S BadgerCare Plus Premium Member / Employer Electronic Funds Transfer and Instructions, Spanish DMS Spanish 05/2014 PDF No
Last revised December 8, 2023