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Data Collection (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 form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-01216 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Regional Model Supplemental Application DHS 36 DQA English 05/2014 PDF No
F-00475 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders: Recertification Application - DHS 36 DQA English 08/2015 PDF No
F-00475 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders: Recertification Application - DHS 36 DQA English 08/2015 Word No
F-02759 Comprehensive Community Services Cost Settlement Advance Request DMS English 01/2024 Word No
F-01270 Comprehensive Community Services Non-Traditional Approval DMS English 07/2014 Word No
F-01270 Comprehensive Community Services Non-Traditional Approval DMS English 07/2014 PDF No
F-25614 Conditional Release Rules and Conditions DCTS English 01/2017 Word No
F-25614 Conditional Release Rules and Conditions DCTS English 01/2017 PDF No
F-25614H Conditional Release Rules and Conditions, Hmong DCTS Hmong 01/2017 Word No
F-25614H Conditional Release Rules and Conditions, Hmong DCTS Hmong 01/2017 PDF No
F-25614S Conditional Release Rules and Conditions, Spanish DCTS Spanish 01/2017 PDF No
F-25614S Conditional Release Rules and Conditions, Spanish DCTS Spanish 01/2017 Word No
F-40054A Confidential Birth Defects Registry - Request to Remove Identifiers DPH English 01/2018 PDF No
F-40054AS Confidential Birth Defects Registry - Request to Remove Identifiers, Spanish DPH Spanish 01/2018 PDF No
F-40054 Confidential Birth Defects Registry Report DPH English 12/2023 PDF No
F-40054 Confidential Birth Defects Registry Report DPH English 12/2023 Word No
F-01068M Confidential Health Survey DMS English 08/2019 Word No
F-01068M Confidential Health Survey DMS English 08/2019 PDF No
F-01068MS Confidential Health Survey, Spanish DMS Spanish 08/2019 PDF No
F-01068MS Confidential Health Survey, Spanish DMS Spanish 08/2019 Word No
F-82009 Confidential Information Release Authorization DES English 07/2008 Word No
F-82009 Confidential Information Release Authorization DES English 07/2008 PDF No
F-82009BU Confidential Information Release Authorization, Burmese DES Burmese 07/2008 PDF No
F-82009H Confidential Information Release Authorization, Hmong DES Hmong 07/2008 PDF No
F-82009RU Confidential Information Release Authorization, Russian DES Russian 07/2008 PDF No
F-82009S Confidential Information Release Authorization, Spanish DES Spanish 07/2008 PDF No
F-82009S Confidential Information Release Authorization, Spanish DES Spanish 07/2008 Word No
F-82009GP Confidential Information Release Authorization: Government Performance and Results Modernization Act of 2010 (GPRA) (7/18/2023) DCTS English 07/2008 PDF No
F-82009GPS Confidential Information Release Authorization: Government Performance and Results Modernization Act of 2010 (GPRA), Spanish (7/18/2023) DCTS Spanish 07/2008 PDF No
F-82009AA Confidential Information Release Authorization: Katie Beckett Program (3/15/2017) DMS English 07/2008 Word Yes
F-82009AAH Confidential Information Release Authorization: Katie Beckett Program, Hmong (3/15/2017) DMS Hmong 07/2008 PDF No
F-82009AAS Confidential Information Release Authorization: Katie Beckett Program, Spanish (3/15/2017) DMS Spanish 07/2008 PDF No
F-82009V Confidential Information Release Authorization: Rehabilitation Review (12/6/2018) OLC English 07/2008 Word No
F-82009Y Confidential Information Release Authorization: Testing Records (7/1/2008) DCTS English 07/2008 Word No
F-82009Y Confidential Information Release Authorization: Testing Records (7/1/2008) DCTS English 07/2008 PDF No
F-82009TC Confidential Information Release Authorization: Transportation Complaint Research (3/1/2013) DMS English 07/2008 Word No
F-82009W Confidential Information Release Authorization: Two Entities (8/3/2020) OLC English 07/2008 Word No
F-82009W Confidential Information Release Authorization: Two Entities (8/3/2020) OLC English 07/2008 PDF No
F-82009WS Confidential Information Release Authorization: Two Entities, Spanish (8/3/2020) OLC Spanish 07/2008 Word No
F-82009WS Confidential Information Release Authorization: Two Entities, Spanish (8/3/2020) OLC Spanish 07/2008 PDF No
F-82009F Confidential Information Release Authorization: WISHIN (5/1/2020) DCTS English 07/2008 Word No
F-82009F Confidential Information Release Authorization: WISHIN (5/1/2020) DCTS English 07/2008 PDF No
F-02829 Confidentiality Agreement For Receipt of CMS Unique ID - SHIP DPH English 01/2024 PDF No
F-81020E Confidentiality and Non-Disclosure Acknowledgement: Volunteer (Food Pantry) DMS English 12/2018 Word No
F-81020A Confidentiality and Non-Disclosure Agreement: Contractor DES English 06/2008 Word No
F-81020A Confidentiality and Non-Disclosure Agreement: Contractor DES English 06/2008 PDF No
F-00978 Confirmation of Confidential Data Destruction - Wisconsin Cancer Reporting System (WCRS) DPH English 03/2014 Word No
F-00896 Conflict of Interest Determination - Wisconsin WIC Program DPH English 05/2017 Word No
F-44243A Congenital Syphilis Case Investigation Report DPH English 08/2021 PDF No
F-21336 Consent for Exchange of Information with Local Educational Agency DMS English 03/2017 Word No

Glossary

 
Last revised December 8, 2023