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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-47479 Trauma Care Facility Classification Application DPH English 05/2024 PDF No
F-02973A Trauma Care Facility Classification Review Committee Application DPH English 02/2022 Word No
F-00602C Trauma Care Facility Classification Review Committee: Focused Visit Action Plan Report DPH English 01/2023 Word No
F-00602 Trauma Care Facility Final Report DPH English 04/2025 Word No
F-00602A Trauma Care Facility In-Person Focused Visit Final Report DPH English 01/2023 Word No
F-00602B Trauma Care Facility Paperwork Submission Focused Visit Cover Sheet DPH English 01/2023 Word No
F-02872 Trauma Care Facility Site Reviewer Performance Assessment DPH English 09/2021 HTML No
F-80190 Travel Reimbursement Request Non-State Employee DES English 09/2024 PDF No
F-80190 Travel Reimbursement Request Non-State Employee DES English 09/2024 Excel No
F-03093A Tribal ADRS Customer Service Agreement DPH English 09/2022 PDF No
F-02057A Tribal ADRS Program Authorization for the Release of Confidential Information DPH English 05/2022 Word No
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH English 08/2019 Excel No
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH English 06/2022 Word No
F-03104 Tribal Aging and Disability Resource Specialist Annual Update Checklist DPH English 11/2022 Word No
F-03104 Tribal Aging and Disability Resource Specialist Annual Update Checklist DPH English 11/2022 HTML No
F-11130 Tribal and Out-of-State Federally Qualified Health Center DMS English 01/2021 Excel No
F-11129A Tribal and Out-of-State Federally Qualified Health Center Cost Report Completion Instructions DMS English 01/2021 PDF No
F-11129 Tribal and Out-of-State Federally Qualified Health Center Cost Report Forms OIG English 01/2021 Excel No
F-11130A Tribal and Out-of-State Federally Qualified Health Center, Instructions DMS English 01/2021 PDF No
F-02462 Tuberculosis (TB) Treatment Assistance Enrollment and Agreement DPH English 10/2019 PDF No
F-02463 Tuberculosis (TB) Treatment Assistance Program - Request for Reimbursement DPH English 03/2025 PDF No
F-02461 Tuberculosis (TB) Treatment Assistance Program - Special Request DPH English 10/2020 PDF No
F-00905A Tuberculosis Contact Window Treatment Initial Request for Medication DPH English 09/2021 PDF No
F-44000 Tuberculosis Disease Initial Request for Medication DPH English 11/2023 PDF No
F-00905 Tuberculosis Infection - Initial Request for Medication DPH English 12/2024 Word No
F-02163 Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement DPH English 03/2025 PDF No
F-42001 Tuberculosis Suspect Case Data DPH English 04/2001 PDF No
F-00634A Types and Locations of Early Intervention Records Birth to 3 Program DMS English 02/2017 Word No
F-00727 Typical Hearing Developmental Milestones DMS English 02/2017 Word No
F-10189 Undue Hardship Bed Hold Notice DMS English 04/2017 Word No
F-10188 Undue Hardship Waiver Decision for Facility DMS English 04/2017 Word No
F-03135 Update to an EMS Service Providers Operational Plan Components Checklist DPH English 03/2023 Word No
F-02140 Urgent Services Agreement DPH English 02/2024 Word No
F-02140 Urgent Services Agreement (DocuSign) DPH English 02/2024 HTML No
F-02140LP Urgent Services Agreement (Large Print) DPH English 02/2024 Word No
F-02140AR Urgent Services Agreement, Arabic DPH Arabic 02/2024 PDF No
F-02140CM Urgent Services Agreement, Chinese (Simplified) DPH Chinese (Simplified) 02/2024 Word No
F-02140H Urgent Services Agreement, Hmong DPH Hmong 02/2024 Word No
F-02140L Urgent Services Agreement, Laotian DPH Laotian 02/2024 Word No
F-02140R Urgent Services Agreement, Russian DPH Russian 02/2024 Word No
F-02140SE Urgent Services Agreement, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word No
F-02140SO Urgent Services Agreement, Somali DPH Somali 02/2024 Word No
F-02140S Urgent Services Agreement, Spanish DPH Spanish 02/2024 Word No
F-00044 User Agreement for System Access DES English 01/2017 Word No
F-02995 Vaccination Community Outreach Grant Quarterly Report DPH English 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 04/2025 PDF No
F-44702H Vaccine Administration Record, Hmong DPH Hmong 04/2025 PDF No
F-44702S Vaccine Administration Record, Spanish DPH Spanish 04/2025 PDF No
F-44702UK Vaccine Administration Record, Ukrainian DPH Ukrainian 04/2025 PDF No
F-03196 Vaccine Borrowing Report DPH English 04/2024 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