Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Title Division Other Locationsort ascending
F-24277 Informed Consent for Psychotropic Medication DCTS
F-02663 Letterhead – EVV Personal Identification Number (PIN) DMS
F-83271 DHS Website Feedback OS
F-10110 Medicaid/BadgerCare Plus Eligibility Certification DMS
F-21225 Program Participation System (PPS): B-3 Module DMS
F-22540 Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs OPIB
F-02349 Children's Long-Term Support (CLTS) Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for County Waiver Agencies DMS
F-02363 Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Service Provider Agencies DMS
F-02364 Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Sole Proprietor or Individual Waiver Service Providers DMS
F-02365 Children's Long-Term Support Waiver Program Provider Agreement and Acknowledgement of Terms of Participation for Fiscal Agents Managing Self-Directed Waiver Supports DMS
F-00119 Personal Care Agency Application for Approval DQA
F-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency DQA
F-62461 Application for Critical Access Hospital Certification of Approval DQA
F-43021 Wisconsin Well Woman Program Multiple Sclerosis (MS) Report and Referral DPH
F-44118 WIC Vendor Application DPH
F-05033 Birth Amendment - Baptismal DPH
F-05034 Certification of Birth Facts for Birth Certificate Amendment from Physician, Hospital, School, Census, Clinic, Nursery, Etc. DPH
F-05004 Birth Amendment - Affidavit DPH
F-05035 Report Change Name, Sex Birth Certificate Surgical Procedure DPH
F-05020 Paternity Order Due to Divorce - Judgment DPH
F-05043 Notice of Removal - Corpse (Hospital, Nursing Home, Hospice) DPH
F-05020A Paternity Order Due to Divorce - Custody DPH
F-05044 Cause of Death Amendment DPH
F-05021C Report of Legal Name Change - Confidential DPH
F-05044C Coroner / Medical Examiner - Cause of Death Amendment DPH
F-05021T Report of Legal Name Change - Tribal DPH
F-05045 Report for Final Disposition DPH
F-05022 Report of Adoption DPH
F-05046 Delayed Death - Court Order DPH
F-05054 Court Order To Amend Cause of Death - 89 DPH
F-05022T Report of Adoption - Tribal DPH
F-05098 Court Order to Correct Facts, Misrepresented Information DPH
F-05023 Acknowledgement of Marital Child DPH
F-05102 Wisconsin Immunization Registry Opt-out Request DPH
F-05024 Voluntary Paternity Acknowledgement DPH
F-05027A Report of Citizenship DPH
F-05210 Name Change Request Within 1st Year DPH
F-05027B Report of Naturalization DPH
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement DPH
F-05032 Report of Birth Certificate Changes After Surrogate Birth DPH
F-42000 Vaccine Order DPH
F-45032 License, Permit or Registration - Radiation Only DPH
F-44824 Wisconsin Day Care Assessment DPH
F-44755 WIC Farmers' Market Nutrition Program DPH
F-44757 WIC Farmer's Market Contract For Farmers DPH
F-40058 Verification of Transfer of USDA Commodities DPH
F-40060 The Emergency Food Assistance Program Commodities Inventory Report DPH
F-12024 Wisconsin Medicaid HMO Enrollment Choice DMS
F-12026 Wisconsin Medicaid and BadgerCare Plus Managed Care Program Continuity of Care Exemption Request DMS
F-12027 Wisconsin Medicaid and BadgerCare Plus Managed Care Program High Risk Pregnancy Exemption Request DMS

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Last Revised: March 23, 2021