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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-03044 1-2 Bed Adult Family Home (AFH) Change Reporting DMS English 06/2022 Word No
F-02602 1-2 Bed Adult Family Home Certification Application Request DMS English 02/2021 Word No
F-03274 1915(i) Housing Support Services Eligibility Evaluation and Needs Assessment DMS English 02/2025 Word No
F-03274 1915(i) Housing Support Services Eligibility Evaluation and Needs Assessment DMS English 02/2025 PDF No
F-03274A 1915(i) Housing Support Services Eligibility Evaluation and Needs Assessment Instructions DMS English 02/2025 PDF No
F-03278 1915(i) Housing Support Services Health and Welfare Affirmation DMS English 02/2025 Word No
F-03278 1915(i) Housing Support Services Health and Welfare Affirmation DMS English 02/2025 PDF No
F-00301 2009 Wisconsin ACT 318 High Cost Mental Health Fund Application DCTS English 08/2016 Word No
F-03054 2022-2023 K-12 COVID-19 Testing Program Participation DPH English 06/2022 HTML No
F-02439-25 2024-2025 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH English 03/2024 HTML No
F-01781 2024–2025 (PHEP BP1) Immunization Program Full-scale Exercise After Action Report/Improvement Plan DPH English 09/2024 Word No
F-01418 21-Day Monitoring Period Chart DPH English 12/2014 PDF No
F-01161 Abortion Certification Statements DMS English 09/2019 Word No
F-01161 Abortion Certification Statements DMS English 09/2019 PDF No
F-40117 Abortion Information Provision Certification DPH English 02/2016 PDF No
F-40117S Abortion Information Provision Certification, Spanish DPH Spanish 02/2016 PDF No
F-01991 ACCESS Application Cover Sheet - Milwaukee Enrollment Services (MilES) (PDF, 90 KB) DMS English 02/2017 PDF No
F-01213 Accessibility Assessment Request DMS English 02/2017 Word No
F-02529 Accreditation Mentoring Program - Mentee Application DPH English 07/2019 PDF No
F-02528 Accreditation Mentoring Program - Mentor Application DPH English 07/2019 PDF No
F-01160 Acknowledgement of Receipt of Hysterectomy Information DMS English 06/2013 Word No
F-01160 Acknowledgement of Receipt of Hysterectomy Information DMS English 06/2013 PDF No
F-01160A Acknowledgement of Receipt of Hysterectomy Information Completion Instructions DMS English 06/2013 PDF No
F-01160AH Acknowledgement of Receipt of Hysterectomy Information Completion Instructions, Hmong DMS Hmong 06/2013 PDF No
F-01160AS Acknowledgement of Receipt of Hysterectomy Information Completion Instructions, Spanish DMS Spanish 06/2013 PDF No
F-01160H Acknowledgement of Receipt of Hysterectomy Information, Hmong DMS Hmong 06/2013 PDF No
F-01160H Acknowledgement of Receipt of Hysterectomy Information, Hmong DMS Hmong 06/2013 Word No
F-01160S Acknowledgement of Receipt of Hysterectomy Information, Spanish DMS Spanish 06/2013 Word No
F-01160S Acknowledgement of Receipt of Hysterectomy Information, Spanish DMS Spanish 06/2013 PDF No
F-02455 Acknowledgement Page: Annual Re-enrollment and Provider Agreement and Vaccine Restitution Agreement DPH English 02/2025 PDF No
F-02474 Active Tuberculosis (TB) Disease Follow-up Report DPH English 03/2019 PDF No
F-42014 Acuity Index DPH English 01/2016 PDF No
F-44151 Acute and Communicable Disease Case Report DPH English 07/2019 Word No
F-44151 Acute and Communicable Disease Case Report DPH English 07/2019 PDF No
F-16004 Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits DMS English 04/2024 PDF No
F-16004H Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Hmong DMS Hmong 04/2024 PDF No
F-16004R Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Russian DMS Russian 04/2024 PDF No
F-16004S Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Spanish DMS Spanish 04/2024 PDF No
F-13046 Adjustment / Reconsideration Request DMS English 02/2025 Word No
F-13046 Adjustment / Reconsideration Request DMS English 02/2025 PDF No
F-13046A Adjustment / Reconsideration Request: Completion Instructions DMS English 02/2025 PDF No
F-16038 Administrative Disqualification Hearing Notice DMS English 08/2023 PDF No
F-16038AR Administrative Disqualification Hearing Notice, Arabic DMS Arabic 08/2023 PDF No
F-16038CM Administrative Disqualification Hearing Notice, Chinese (Simplified) DMS Chinese (Simplified) 08/2023 PDF No
F-16038G Administrative Disqualification Hearing Notice, German DMS German 08/2023 PDF No
F-16038H Administrative Disqualification Hearing Notice, Hmong DMS Hmong 08/2023 PDF No
F-16038L Administrative Disqualification Hearing Notice, Laotian DMS Laotian 08/2023 PDF No
F-16038R Administrative Disqualification Hearing Notice, Russian DMS Russian 08/2023 PDF No
F-16038SO Administrative Disqualification Hearing Notice, Somali DMS Somali 08/2023 PDF No
F-16038S Administrative Disqualification Hearing Notice, Spanish DMS Spanish 08/2023 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