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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-01010 Wisconsin Medicaid - Hospice Benefit Revocation (Non-Recertification) / Voluntary Discharge DMS English 08/2019 Word No
F-01010 Wisconsin Medicaid - Hospice Benefit Revocation (Non-Recertification) / Voluntary Discharge DMS English 08/2019 PDF No
F-10093 Wisconsin Medicaid and BadgerCare Plus Overpayment Notice DMS English 09/2019 Word No
F-01003 Wisconsin Medicaid Certification of Public Expenditures DMS English 07/2008 PDF No
F-13150 Wisconsin Medicaid Confidential or Alternative Communication Request DMS English 04/2019 PDF No
F-11079A Wisconsin Medicaid Cost Report for Independent and Provider-Based (Affiliated Hospital Having More Than 50 Beds)Rural Health Clinics Completion Instructions DMS English 07/2017 PDF No
F-00312 Wisconsin Medicaid CRS Benefit Provider Agreement and Acknowledgement of Terms of Participation DCTS English 08/2016 Word No
F-00312A Wisconsin Medicaid CRS Benefit Provider Agreement and Acknowledgement of Terms of Participation for Individual or Non-Specified Community Recovery Services Providers DCTS English 08/2016 Word No
F-01009A Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under DMS English 12/2010 Word No
F-01009A Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under DMS English 12/2010 PDF No
F-01009AH Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under, Hmong DMS Hmong 12/2010 PDF No
F-01009AH Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under, Hmong DMS Hmong 12/2010 Word No
F-01009AS Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under, Spanish DMS Spanish 12/2010 PDF No
F-01009AS Wisconsin Medicaid Election of Hospice Benefit for Members 20 and Under, Spanish DMS Spanish 12/2010 Word No
F-01009B Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older DMS English 12/2010 PDF No
F-01009B Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older DMS English 12/2010 Word No
F-01009BH Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older, Hmong DMS Hmong 12/2010 PDF No
F-01009BH Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older, Hmong DMS Hmong 12/2010 Word No
F-01009BS Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older, Spanish DMS Spanish 12/2010 Word No
F-01009BS Wisconsin Medicaid Election of Hospice Benefit for Members 21 and Older, Spanish DMS Spanish 12/2010 PDF No
F-10101 Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet DMS English 03/2024 PDF Yes
F-10101DA Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Dari DMS Dari (Afghan Persian) 03/2024 PDF No
F-10101H Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Hmong DMS Hmong 03/2024 PDF No
F-10101PA Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Pashto DMS Pashto 03/2024 PDF No
F-10101S Wisconsin Medicaid for the Elderly, Blind, or Disabled Application Packet, Spanish DMS Spanish 03/2024 PDF No
F-13152 Wisconsin Medicaid HIPAA Privacy Complaint DMS English 08/2018 PDF No
F-13147 Wisconsin Medicaid HIPAA Privacy Restriction Request DMS English 07/2008 PDF No
F-01008 Wisconsin Medicaid Notification of Hospice Benefit Election DMS English 05/2023 PDF No
F-01008 Wisconsin Medicaid Notification of Hospice Benefit Election DMS English 05/2023 Word No
F-01011 Wisconsin Medicaid Physician Certification / Recertification of Terminal Illness DMS English 08/2019 PDF No
F-01011 Wisconsin Medicaid Physician Certification / Recertification of Terminal Illness DMS English 08/2019 Word No
F-01477 Wisconsin Medicaid Program Nursing Home Cost Report Website User Request DMS English 02/2017 Word No
F-00180C Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation DMS English 09/2024 Word No
F-00180CS Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation, Spanish DMS Spanish 09/2024 Word No
F-03357 Wisconsin Medicaid Provider Enrollment Waiver or Variance Request OIG English 01/2025 Word No
F-03263 Wisconsin Medicaid Provider Self-Audit Overpayment Report OIG English 01/2024 PDF No
F-10140 Wisconsin Medicaid Supplement to FoodShare Wisconsin Application DMS English 10/2012 PDF No
F-10140S Wisconsin Medicaid Supplement to FoodShare Wisconsin Application, Spanish DMS Spanish 10/2012 PDF No
F-10129 Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application DMS English 06/2023 PDF No
F-10129H Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Hmong DMS Hmong 06/2023 PDF No
F-10129S Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, Spanish DMS Spanish 06/2023 PDF No
F-00986 Wisconsin Newborn Screening Program (NBS) - Condition Nomination DPH English 03/2014 Word No
F-01844 Wisconsin Notification of Death - Accounting of Estate Funds DMS English 05/2021 PDF No
F-01844 Wisconsin Notification of Death - Accounting of Estate Funds DMS English 05/2021 Word No
F-03211 Wisconsin Nurse Aide Registry Renewal Form DQA English 11/2024 PDF No
F-43023 Wisconsin Organ and Tissue Recovery and Assessment (ORGAN - SPECIFIC) DPH English 08/2006 PDF No
F-43024 Wisconsin Organ and Tissue Recovery and Assessment (TISSUE - SPECIFIC) DPH English 08/2006 PDF No
F-00975 Wisconsin Public Health Registration for Electronic Data Submission (PHREDS) DPH English 11/2024 HTML No
F-03230 Wisconsin Reciprocity Application Checklist DPH English 10/2023 PDF No
F-13162 Wisconsin SeniorCare HIPAA Privacy Access Request DMS English 07/2008 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