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Official DHS Forms Library

Temporary closure notice

The DHS forms and publications center is moving! To allow time for this move, we will not be processing any paper order requests October 9 through October 21. Any requests received during this time will be processed in the order they were received, beginning October 22.

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-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS English 07/2012 PDF 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
F-00981 Respondent / Patient Opt-out Card, Wisconsin Cancer Reporting System (WCRS) DPH English 03/2021 Word No
F-40108 Retail Vendor Application Amendment Wisconsin Women, Infant, and Children (WIC) DPH English 03/2024 PDF No
F-01999A Retired Senior Volunteer Program: State Match Funding Application DPH English 09/2019 Word No
F-01800 Retroactive Overtime To Be Paid DMS English 01/2019 Word No
F-21189 Rights of Detention DCTS English 05/2017 Word No
F-21189S Rights of Detention, Spanish DCTS Spanish 05/2017 Word No
F-62601 Rights of Home Health Agency Patients DQA English 01/2025 PDF No
F-62601S Rights of Home Health Agency Patients, Spanish DQA Spanish 01/2025 PDF No
F-01558 Risk Agreement - IRIS Program DMS English 09/2023 Word No
F-00945 Risk Identification and Assessment Worksheet and Purchase of Service Audit Waiver Request OS English 11/2023 HTML No
F-00945i Risk Identification and Assessment Worksheet and Purchase of Service Audit Waiver Request Instructions OS English 11/2023 PDF No
F-11025 Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs DMS English 04/2009 Word No
F-11025 Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs DMS English 04/2009 PDF No
F-11025A Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs Instructions DMS English 04/2009 PDF No
F-11026 Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs DMS English 04/2009 PDF No
F-11026 Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs DMS English 04/2009 Word No
F-11026A Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs Completion Instructions DMS English 04/2014 PDF No
F-11081 Rural Health Clinic Provider Staff Encounters DMS English 10/2016 Excel No
F-11027 Rural Health Clinic Quarterly Cost Report DMS English 10/2016 Excel No
F-11027A Rural Health Clinic Quarterly Cost Report Completion Instructions DMS English 10/2016 PDF No
F-11022 Rural Health Clinic Statistical Data DMS English 10/2016 PDF No
F-11022 Rural Health Clinic Statistical Data DMS English 10/2016 Word No
F-03081 Safe and Healthy Home Assessment DPH English 12/2022 Excel No
F-03081 Safe and Healthy Home Assessment DPH English 08/2022 PDF No
F-02828 School P-EBT Verification Letter Template DMS English 06/2021 Word 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 August 28, 2025