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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-02746 Request for Institution of Mental Disease Determination for Residential Substance Use Disorder Facilities DMS English 12/2020 Word No
F-20448 Request for Medicaid Administrative Funds - Staff Position DMS English 03/2017 Word No
F-02937 Request for Medicaid Coverage Consideration for Procedures and Devices DMS English 02/2022 HTML No
F-01020A Request for Nursing Home Care Determination Completion Instructions DMS English 02/2017 PDF No
F-62457 Request for Permission to Start Construction for Footings and Foundations DQA English 01/2021 PDF No
F-62457 Request for Permission to Start Construction for Footings and Foundations DQA English 01/2021 Word No
F-00330 Request for Replacement FoodShare and/or Summer EBT Benefits DMS English 10/2024 PDF No
F-00330AR Request for Replacement FoodShare and/or Summer EBT Benefits, Arabic DMS Arabic 10/2024 PDF No
F-00330CM Request for Replacement FoodShare and/or Summer EBT Benefits, Chinese (Simplified) DMS Chinese (Simplified) 10/2024 PDF No
F-00330G Request for Replacement FoodShare and/or Summer EBT Benefits, German DMS German 10/2024 PDF No
F-00330H Request for Replacement FoodShare and/or Summer EBT Benefits, Hmong DMS Hmong 10/2024 PDF No
F-00330L Request for Replacement FoodShare and/or Summer EBT Benefits, Laotian DMS Laotian 10/2024 PDF No
F-00330R Request for Replacement FoodShare and/or Summer EBT Benefits, Russian DMS Russian 10/2024 PDF No
F-00330SO Request for Replacement FoodShare and/or Summer EBT Benefits, Somali DMS Somali 10/2024 PDF No
F-00330S Request for Replacement FoodShare and/or Summer EBT Benefits, Spanish DMS Spanish 10/2024 PDF No
F-20572 Request for State Public Funding for Non-Residents DCTS English 05/2020 Word No
F-62608 Request for Use of Medical Restraints DMS English 03/2017 PDF No
F-62608 Request for Use of Medical Restraints DMS English 03/2017 Word No
F-00926A Request for Use of Medical Restraints - CLTSS DMS English 02/2017 PDF No
F-00926A Request for Use of Medical Restraints - CLTSS DMS English 02/2017 Word No
F-62607 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan DMS English 03/2017 Word No
F-62607 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan DMS English 03/2017 PDF No
F-00569 Request for Waiver of Administrative Rule for Licensure DPH English 09/2019 Word No
F-03282 Request for Waiver of Administrative Rule—Trauma Care Services DPH English 06/2024 PDF No
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS English 07/2012 PDF No
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS English 07/2012 Word No
F-00054A Request for Waiver of Requirements Relating to Co-Location of an ADRC and ICA/MCO or ADRC and Staff Subcontracted to an ICA/MCO DPH English 07/2016 Word No
F-00054B Request for Waiver of Requirements Relating to Organizational Separation when MCO Care Management is Subcontracted to the Same Agency Responsible for ADRC DPH English 07/2016 Word No
F-22539 Request for Waiver of State SSI or Caretaker Supplement Overpayment Recovery or Change in Repayment Rate DMS English 06/2015 PDF No
F-00054D Request for Waiver of the 0.5 Full-Time Equivalent Requirement for ADRC Staff DPH English 07/2016 Word No
F-02068 Request to Establish a Children's COP Risk Reserve DMS English 04/2017 Word No
F-03266 Request to Lower Your FoodShare Overpayment DMS English 02/2024 PDF No
F-03266H Request to Lower Your FoodShare Overpayment, Hmong DMS Hmong 02/2024 PDF No
F-03266S Request to Lower Your FoodShare Overpayment, Spanish DMS Spanish 02/2024 PDF No
F-19002 Request to Reduce QUEST Card Balance DMS English 08/2023 PDF No
F-01845 Request to Remain on the Wisconsin HIV Drug Assistance Program (HDAP) and Decline Enrollment in Health Insurance DPH English 01/2025 PDF No
F-01845S Request to Remain on the Wisconsin HIV Drug Assistance Program (HDAP) and Decline Enrollment in Health Insurance, Spanish DPH Spanish 01/2025 PDF No
F-62373 Resident Evacuation Assessment DQA English 04/2009 Word No
F-62373 Resident Evacuation Assessment DQA English 04/2009 PDF No
F-02282A Resident Relocation Plan DMS English 10/2023 Word No
F-02282 Resident Relocation Roster DMS English 07/2018 Excel No
F-02634C Residential Care Apartment Complex (RCAC) Initial Survey Checklist DQA English 03/2020 Word No
F-02766 Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members DMS English 06/2023 PDF No
F-02766 Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members DMS English 06/2023 Word No
F-03082E Residential Substance Use Treatment Services (DHS 75.53, DHS 75.54, DHS 75.55, DHS 75.56, DHS 75.57, DHS 75.58) Initial Certification or Change of Ownership Application DQA English 06/2025 Word No
F-03382 Residential Treatment Facility – Adult Residential Integrated Behavioral Health Stabilization Service DHS 75.56 - Applicant Compliance Statement DQA English 05/2025 Word No
F-03381 Residential Treatment Facility – Medically Monitored Residential Treatment Service DHS 75.54 - Applicant Compliance Statement DQA English 05/2025 Word No
F-03383 Residential Treatment Facility – Residential Withdrawal Management Service DHS 75.57 - Applicant Compliance Statement DQA English 05/2025 Word No
F-03380 Residential Treatment Facility – Transitional Residential Treatment Service DHS 75.53 - Applicant Compliance Statement DQA English 05/2025 Word No
F-03147 Resilient Wisconsin Help the Helper Training Evaluation DCTS English 04/2023 HTML 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