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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-00889 Designation of Confidential and Proprietary Information - Managed LTC Business Plan DMS English 08/2022 PDF No
F-21072 Determination of Exceptional Care Needs for Children in Child Care or Foster Care Setting DMS English 03/2017 Word No
F-02897 DHS 75 Implementation Questions DCTS English 10/2021 HTML No
F-03089 DHS 75 Residential Services Fit and Qualified Application DQA English 08/2022 Word No
F-02903 DHS Office of the Secretary External Event Request OS English 06/2022 HTML No
F-02069 DHS Quarterly Report on Consumers Enrolled in CCS DCTS English 01/2024 HTML No
F-02825 DHS Stockpile Request DPH English 03/2024 HTML No
F-03170 DHS Tuberculosis Program and Refugee Health Liaison Feedback Survey DPH English 05/2023 HTML No
F-83271 DHS Website Feedback OS English 03/2017 HTML No
F-43009 Diabetes Emergency Action Plan DPH English 03/2010 PDF No
F-43013 Diabetes Medical Management Plan DPH English 06/2016 PDF No
F-02863 Disability Benefit Specialist Program Appointed Representative Agreement DPH English 04/2022 Word No
F-02863 Disability Benefit Specialist Program Appointed Representative Agreement DPH English 04/2022 HTML No
F-02863 Disability Benefit Specialist Program Appointed Representative Agreement, Instructions DPH English 04/2022 PDF No
F-02863LP Disability Benefit Specialist Program Appointed Representative Agreement, Large Print DPH English 04/2022 Word No
F-02863S Disability Benefit Specialist Program Appointed Representative Agreement, Spanish DPH Spanish 08/2021 Word No
F-03030 Disability Benefit Specialist Program Case Closing Letter DPH English 05/2022 Word No
F-03030LP Disability Benefit Specialist Program Case Closing Letter, Large Print DPH English 05/2022 Word No
F-03030S Disability Benefit Specialist Program Case Closing Letter, Spanish DPH Spanish 05/2022 Word No
F-02562 Disability Benefit Specialist Program Client Services Agreement DPH English 02/2022 HTML No
F-02562 Disability Benefit Specialist Program Client Services Agreement DPH English 02/2022 Word No
F-02562A Disability Benefit Specialist Program Client Services Agreement, Instructions DPH English 02/2022 PDF No
F-02562LP Disability Benefit Specialist Program Client Services Agreement, Large Print DPH English 02/2022 Word No
F-02562S Disability Benefit Specialist Program Client Services Agreement, Spanish DPH Spanish 02/2022 Word No
F-02339 Disaster Response Interpreter (DRI) Deployment Checklist for Community Shelters and Media Events DPH English 06/2018 PDF No
F-16025 Disqualification Consent Agreement DMS English 07/2023 PDF No
F-16025AR Disqualification Consent Agreement, Arabic DMS Arabic 07/2023 PDF No
F-16025CM Disqualification Consent Agreement, Chinese Mandarin DMS Chinese Mandarin 07/2023 PDF No
F-16025G Disqualification Consent Agreement, German DMS German 05/2018 PDF No
F-16025H Disqualification Consent Agreement, Hmong DMS Hmong 07/2023 PDF No
F-16025L Disqualification Consent Agreement, Laotian DMS Laotian 05/2018 PDF No
F-16025R Disqualification Consent Agreement, Russian DMS Russian 07/2023 PDF No
F-16025SO Disqualification Consent Agreement, Somali DMS Somali 07/2023 PDF No
F-16025S Disqualification Consent Agreement, Spanish DMS Spanish 07/2023 PDF No
F-02962 Disseminated Gonococcal Infection Provider Worksheet DPH English 02/2022 PDF No
F-10193 Divestment Penalty and Undue Hardship Notice Plus Waiver Request DMS English 08/2021 PDF No
F-10193S Divestment Penalty and Undue Hardship Notice Plus Waiver Request, Spanish DMS Spanish 08/2021 PDF No
F-00607 Division of Quality Assurance (DQA) - Misconduct Report or Complaint about Care or Treatment DQA English 02/2023 HTML No
F-44764 DNR Bracelet Insert DPH English 07/2020 PDF No
F-43025 Document of Anatomical Gift Authorization for Organ and Tissue Donation DPH English 12/2018 PDF No
F-43025S Document of Anatomical Gift Authorization for Organ and Tissue Donation, Spanish DPH Spanish 12/2018 PDF No
F-02859 DPH Speaker Request DPH English 08/2021 HTML No
F-62096A DQA Authority for Obtaining Provider Records Without Written Release DQA English 10/2018 PDF No
F-03189 DQA Corporate Guardianship Provider Agreement DQA English 10/2023 PDF No
F-62188 DQA External Request for Presenter DQA English 02/2024 HTML No
F-02426 DQA Misconduct Incident Reporting (MIR) System Account Registration Survey DQA English 11/2018 HTML No
F-02657 DQA Post Survey Questionnaire: Clinical Laboratory Improvement Amendments (CLIA) DQA English 05/2020 Word No
F-00020 Drug Addition Review Request DMS English 04/2014 Word No
F-00020 Drug Addition Review Request DMS English 04/2014 PDF No
F-62643 Drug Repository Program Notice of Participation or Withdrawal DQA English 02/2022 Word No
Last revised December 8, 2023