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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-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-03018 1-2 Bed Adult Family Home Certification: Review Tool and Corrective Plan DMS English 07/2023 Word No
F-00301 2009 Wisconsin ACT 318 High Cost Mental Health Fund Application DCTS English 08/2016 Word No
F-02439-22 2021-2022 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH English 02/2019 HTML No
F-02439-23 2022-2023 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH English 03/2023 HTML No
F-03054 2022-2023 K-12 COVID-19 Testing Program Participation DPH English 06/2022 HTML No
F-01781 2023-2024 (PHEP BP5) Immunization Program Functional Exercise After Action Report/Improvement Plan DPH English 08/2023 Word No
F-02439-24 2023-2024 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH English 07/2023 HTML No
F-01611 2024 Maternal Child Health (MCH) Objective Supplement DPH English 08/2023 HTML 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-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 Word No
F-01160H Acknowledgement of Receipt of Hysterectomy Information, Hmong DMS Hmong 06/2013 PDF No
F-01160S Acknowledgement of Receipt of Hysterectomy Information, Spanish DMS Spanish 06/2013 PDF No
F-01160S Acknowledgement of Receipt of Hysterectomy Information, Spanish DMS Spanish 06/2013 Word No
F-02455 Acknowledgement Page: Annual Re-enrollment and Provider Agreement and Vaccine Restitution Agreement DPH English 01/2023 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 09/2021 PDF No
F-16004H Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Hmong DMS Hmong 09/2021 PDF No
F-16004R Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Russian DMS Russian 09/2021 PDF No
F-16004S Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits, Spanish DMS Spanish 09/2021 PDF No
F-13046 Adjustment / Reconsideration Request DMS English 08/2015 Word No
F-13046 Adjustment / Reconsideration Request DMS English 08/2015 PDF No
F-13046A Adjustment / Reconsideration Request: Completion Instructions DMS English 08/2015 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 DMS Chinese Mandarin 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
F-25213 Admission to Caseload - Mental Health DCTS English 12/2016 PDF No
F-25213 Admission to Caseload - Mental Health DCTS English 12/2016 Word No
Last revised July 18, 2023