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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-00989HS Child/Family Outcome (IFSP), Spanish DMS Spanish 02/2017 Word No
F-01997 Children's Community Options (CCOP) Reconciliation Packet DMS English 02/2022 Excel No
F-01997I Children's Community Options (CCOP) Reconciliation Packet, Instructions DMS English 02/2022 PDF No
F-02587 Children's Long-Term Support (CLTS) Waiver Program Deciding Together Implementation Planning Tool DMS English 12/2019 Word No
F-03344 Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation DMS English 02/2025 PDF No
F-02349 Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for County Waiver Agencies DMS English 05/2025 PDF No
F-03344S Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation, Spanish DMS Spanish 02/2025 PDF No
F-03334 Children's Long-Term Support (CLTS) Waiver Program Timely Filing Claim Exception Request DMS English 05/2025 PDF No
F-03334 Children's Long-Term Support (CLTS) Waiver Program Timely Filing Claim Exception Request DMS English 05/2025 Word No
F-01338 Children's Long-Term Support Parental Fee Declaration – Model DMS English 02/2023 Word No
F-01338H Children's Long-Term Support Parental Fee Declaration, Hmong – Model DMS Hmong 02/2023 Word No
F-01338S Children's Long-Term Support Parental Fee Declaration, Spanish – Model DMS Spanish 02/2023 Word No
F-02467 Children's Long-Term Support: Care Level Classification DMS English 01/2022 Word No
F-00963 Children’s Long Term Support Reconciliation Packet DMS English 02/2022 Excel No
F-00963I Children’s Long Term Support Reconciliation Packet, Instructions DMS English 02/2022 PDF No
F-02538 Children’s Long-Term Support Waiver Program: Outlier Rate Request DMS English 04/2022 Word No
F-01593A Civil Money Penalty (CMP) Funded Project Report DQA English 02/2020 Word No
F-80983 Civil Rights Complaint OLC English 10/2025 PDF No
F-80983BU Civil Rights Complaint, Burmese OLC Burmese 10/2025 PDF No
F-80983H Civil Rights Complaint, Hmong OLC Hmong 10/2025 PDF No
F-80983S Civil Rights Complaint, Spanish OLC Spanish 10/2025 PDF No
F-00165 Civil Rights Compliance Letter of Assurance OLC English 12/2021 Word No
F-13470 Claim Form Attachment Cover Page DMS English 03/2023 PDF No
F-13470 Claim Form Attachment Cover Page DMS English 03/2023 Word No
F-13470A Claim Form Attachment Cover Page: Instructions DMS English 03/2023 PDF No
F-13066 Claim Refund DMS English 08/2012 PDF No
F-13066 Claim Refund DMS English 08/2012 Word No
F-13066A Claim Refund Completion Instructions DMS English 08/2012 PDF No
F-02022 Claims Audit Report for Managed Long-Term Care MCOs DMS English 11/2025 Word No
F-01735 CLIA Laboratory Test Methodology Report DQA English 05/2016 Word No
F-01409 Client Intake and Asthma Screening DPH English 09/2024 PDF No
F-26100 Client Rights Limitation or Denial Documentation DCTS English 03/2019 PDF No
F-26100 Client Rights Limitation or Denial Documentation DCTS English 03/2019 Word No
F-26100A Client Rights Limitation or Denial Documentation Review Schedule Supplement DCTS English 01/2017 PDF No
F-26100A Client Rights Limitation or Denial Documentation Review Schedule Supplement DCTS English 01/2017 Word No
F-26100S Client Rights Limitation or Denial Documentation, Spanish DCTS Spanish 03/2019 Word No
F-26100S Client Rights Limitation or Denial Documentation, Spanish DCTS Spanish 03/2019 PDF No
F-02823 Client Rights Quiz DCTS English 06/2021 HTML No
F-02400A Client Transfer: Assisted Living Facility Capability DQA English 01/2019 PDF No
F-02400A Client Transfer: Assisted Living Facility Capability DQA English 01/2019 Word No
F-02400 Client Transfer: Assisted Living Facility Client Face Sheet DQA English 01/2019 Word No
F-02400 Client Transfer: Assisted Living Facility Client Face Sheet DQA English 01/2019 PDF No
F-02400B Client Transfer: Labels DQA English 01/2019 PDF No
F-02400B Client Transfer: Labels DQA English 01/2019 Word No
F-03127 Climate and Health Toolkit Feedback Survey DPH English 02/2023 HTML No
F-02924 Clinical Chart Review Tool DPH English 03/2022 Word No
F-03148 Clinical Data Request - Wisconsin WIC Program, English and Spanish DPH English, Spanish 10/2024 Word No
F-03408 CLTS Council Representative Application DMS English 10/2025 HTML No
F-02749 CLTS Exceptional Expense Notification DMS English 02/2023 Word No
F-02749I CLTS Exceptional Expense Notification, Instructions DMS English 02/2023 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.

Glossary

 
Last revised October 27, 2025