Skip to main content

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-16019PA Wisconsin FoodShare Application, Pashto DMS Pashto 10/2024 PDF No
F-16019R Wisconsin FoodShare Application, Russian DMS Russian 10/2024 PDF No
F-16019SO Wisconsin FoodShare Application, Somali DMS Somali 10/2024 PDF No
F-16019S Wisconsin FoodShare Application, Spanish DMS Spanish 10/2024 PDF No
F-16019V Wisconsin FoodShare Application, Vietnamese DMS Vietnamese 10/2024 PDF No
F-10141 Wisconsin Funeral and Cemetery Aids Program Application DMS English 05/2022 PDF No
F-03085A Wisconsin Healthy Smiles Survey: Individual Consent DPH English 06/2024 PDF No
F-03085AH Wisconsin Healthy Smiles Survey: Individual Consent, Hmong DPH Hmong 06/2024 PDF No
F-03085ASO Wisconsin Healthy Smiles Survey: Individual Consent, Somali DPH Somali 06/2024 PDF No
F-03085AS Wisconsin Healthy Smiles Survey: Individual Consent, Spanish DPH Spanish 06/2024 PDF No
F-03085B Wisconsin Healthy Smiles Survey: Individual Opt-Out DPH English 06/2024 PDF No
F-03085BH Wisconsin Healthy Smiles Survey: Individual Opt-Out, Hmong DPH Hmong 06/2024 PDF No
F-03085BSO Wisconsin Healthy Smiles Survey: Individual Opt-Out, Somali DPH Somali 06/2024 PDF No
F-03085BS Wisconsin Healthy Smiles Survey: Individual Opt-Out, Spanish DPH Spanish 06/2024 PDF No
F-03085 Wisconsin Healthy Smiles Survey: Site Agreement DPH English 08/2022 PDF No
F-01184 Wisconsin Hemophilia Home Care Program Application DMS English 08/2020 PDF No
F-01184AH Wisconsin Hemophilia Home Care Program Application Instructions, Hmong DMS Hmong 08/2020 PDF No
F-01184AS Wisconsin Hemophilia Home Care Program Application Instructions, Spanish DMS Spanish 08/2020 PDF No
F-01184H Wisconsin Hemophilia Home Care Program Application, Hmong DMS Hmong 08/2020 PDF No
F-01184A Wisconsin Hemophilia Home Care Program Application, Instructions DMS English 08/2020 PDF No
F-01184S Wisconsin Hemophilia Home Care Program Application, Spanish DMS Spanish 08/2020 PDF No
F-01187 Wisconsin Hemophilia Home Care Program Financial Need Statement DMS English 05/2025 PDF No
F-01187A Wisconsin Hemophilia Home Care Program Financial Need Statement Instructions DMS English 05/2025 PDF No
F-01187AH Wisconsin Hemophilia Home Care Program Financial Need Statement Instructions, Hmong DMS Hmong 05/2025 PDF No
F-01187AS Wisconsin Hemophilia Home Care Program Financial Need Statement Instructions, Spanish DMS Spanish 05/2025 PDF No
F-01187H Wisconsin Hemophilia Home Care Program Financial Need Statement, Hmong DMS Hmong 05/2025 PDF No
F-01187S Wisconsin Hemophilia Home Care Program Financial Need Statement, Spanish DMS Spanish 05/2025 PDF No
F-01145 Wisconsin Hemophilia Home Care Program Residency Verification DMS English 05/2025 PDF No
F-01145H Wisconsin Hemophilia Home Care Program Residency Verification, Hmong DMS Hmong 05/2025 PDF No
F-01145S Wisconsin Hemophilia Home Care Program Residency Verification, Spanish DMS Spanish 05/2025 PDF No
F-44338 Wisconsin HIV Case Report DPH English 01/2024 Word No
F-44338 Wisconsin HIV Case Report DPH English 01/2024 PDF No
F-01670 Wisconsin HIV Drug Assistance Program (HDAP) Exception Report DPH English 01/2025 PDF No
F-01670S Wisconsin HIV Drug Assistance Program (HDAP) Exception Report, Spanish DPH Spanish 01/2025 PDF No
F-00916 Wisconsin HIV Drug Assistance Program / Wisconsin Chronic Disease Program / Wisconsin Well Woman Program Provider File Update Request DMS English 02/2025 PDF No
F-00916 Wisconsin HIV Drug Assistance Program / Wisconsin Chronic Disease Program / Wisconsin Well Woman Program Provider File Update Request DMS English 02/2025 Word No
F-00916A Wisconsin HIV Drug Assistance Program / Wisconsin Chronic Disease Program / Wisconsin Well Woman Program Provider File Update Request Completion Instructions DMS English 02/2025 PDF No
F-44257 Wisconsin Immunization Record Card DPH English 11/2022 PDF Yes
F-02487 Wisconsin Immunization Registry (WIR) Record Release Authorization DPH English 05/2019 PDF No
F-02487CM Wisconsin Immunization Registry (WIR) Record Release Authorization, Chinese (Simplified) DPH Chinese (Simplified) 05/2019 PDF No
F-02487HI Wisconsin Immunization Registry (WIR) Record Release Authorization, Hindi DPH Hindi 05/2019 PDF No
F-02487H Wisconsin Immunization Registry (WIR) Record Release Authorization, Hmong DPH Hmong 05/2019 PDF No
F-02487SO Wisconsin Immunization Registry (WIR) Record Release Authorization, Somali DPH Somali 05/2019 PDF No
F-02487S Wisconsin Immunization Registry (WIR) Record Release Authorization, Spanish DPH Spanish 05/2019 PDF No
F-05102 Wisconsin Immunization Registry Opt-out Request DPH English 07/2019 PDF Yes
F-03037 Wisconsin Lead-in Water Testing and Remediation (WTR) Initiative DPH English 05/2022 PDF No
F-10144 Wisconsin Life Insurance Inquiry DMS English 05/2019 Word No
F-05281 Wisconsin Marriage Certificate Application DPH English 12/2023 PDF No
F-05281S Wisconsin Marriage Certificate Application, Spanish DPH Spanish 01/2024 PDF No
F-11048 Wisconsin Medicaid - Certification of Need for Emergency Psychiatric / Substance Abuse Admission to Hospital Institutions for Mental Disease for Members Under Age 21 and in Case of Medicaid Determination after Admission DMS English 02/2009 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.

Glossary

 
Last revised December 4, 2024