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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-00367K Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 14 - 18 Years DMS English 02/2017 PDF No
F-00367D Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 to 24 Months DMS English 02/2017 PDF No
F-00367L Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 Years and Up DMS English 02/2017 PDF No
F-00367E Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 24 to 36 Months DMS English 02/2017 PDF No
F-00367F Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 36 Months - 4 Years DMS English 02/2017 PDF No
F-00367G Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years DMS English 02/2017 PDF No
F-00367B Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 12 Months DMS English 02/2017 PDF No
F-00367H Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 9 Years DMS English 12/2012 PDF No
F-00367I Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 9 - 12 Years DMS English 02/2017 PDF No
F-00367A Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: Birth - 6 Months DMS English 02/2017 PDF No
F-20418 Agency Application for Access to Web-Based Personal Care Screening Tool, PDF DMS English 03/2017 PDF No
F-20418 Agency Application for Access to Web-Based Personal Care Screening Tool, Word DMS English 03/2017 Word No
F-00639 Agency Data Security Staff User Agreement DMS English 02/2020 PDF No
F-10172 Agency Response to the State Quality Assurance (QA) Medicaid Finding DMS English 07/2008 PDF No
F-00983 Aggregate Data Request - Wisconsin Cancer Reporting System (WCRS) DPH English 06/2022 Word No
F-02888 Aging & Disability Resource Center Annual Update Checklist DPH English 09/2024 HTML No
F-02888 Aging & Disability Resource Center Annual Update Checklist DPH English 09/2024 Word No
F-00052A Aging and Disability Resource Center (ADRC) Annual Budget DPH English 02/2017 Excel No
F-00052 Aging and Disability Resource Center (ADRC) Application DPH English 03/2022 Word No
F-00052I Aging and Disability Resource Center (ADRC) Application: Instructions DPH English 03/2022 PDF No
F-02034 Aging/ADRC Integration Funding Budget Worksheet DPH English 05/2019 Excel No
F-00974 Agreement Between State of Wisconsin Department of Health Services - WIC and Senior Farmers' Market Nutrition Program (FMNP) DPH English 01/2025 PDF No
F-40036 Agreement Between the State of Wisconsin and the Wisconsin Women, Infant, and Children (WIC) Vendor DPH English 11/2022 PDF No
F-03151 AIDS Service Organization Designation Request DPH English 01/2025 PDF No
F-01571 Air Quality Measurement Device Maintenance and Calibration Log DPH English 06/2015 Word No
F-62617 Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report DQA English 03/2024 Word No
F-02659 Alternate Electronic Visit Verification (EVV) Attestation DMS English 08/2023 PDF No
F-21343 Alzheimer's Family and Caregiver Support Program (AFCSP) Budget Report DPH English 10/2024 HTML No
F-21343A Alzheimer's Family and Caregiver Support Program (AFCSP) Financial Eligibility Screen - Worksheets 1 and 2 DPH English 04/2020 Word No
F-21343E Alzheimer's Family and Caregiver Support Program (AFCSP) General Information DPH English 04/2020 Word No
F-21343AS Alzheimer's Family Caregiver Support Program (AFCSP) Financial Eligibility Screen - Worksheet 1, Spanish DPH Spanish 04/2020 Word No
F-21343ES Alzheimer's Family Caregiver Support Program (AFCSP) General Information, Spanish DPH Spanish 04/2020 Word No
F-47247 Ambulance Attendant License/Permit Renew DPH English 08/2010 HTML No
F-03328 American Sign Language (ASL) Interpreter and Captioning Request DPH English 11/2024 HTML No
F-62502 Analyst Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 05/2020 Word No
F-62502 Analyst Application to Perform Alcohol, Controlled Substance, and Controlled Substance Analog Testing DQA English 05/2020 PDF No
F-02454 Annual Re-enrollment and Provider Agreement - Vaccine for Children Program DPH English 02/2025 Word No
F-02817 Annual Review for Division of Medicaid Services (DMS) Vendors DMS English 06/2024 Word No
F-40093 Annual ROSIE User Security and Confidentiality Agreement DPH English 12/2019 PDF No
F-40093 Annual ROSIE User Security and Confidentiality Agreement DPH English 12/2019 Word No
F-00913 Annual Survey of Intermediate Care Facilities - 2024 DQA English 03/2025 Word No
F-44126 Antituberculosis Therapy Program Medication Refill Request DPH English 02/2024 PDF No
F-00237 Appeal Request - MCOs - Care Wisconsin DMS English 01/2019 Word No
F-00237AR Appeal Request - MCOs - Care Wisconsin, Arabic DMS Arabic 01/2019 Word No
F-00237CM Appeal Request - MCOs - Care Wisconsin, Chinese (Simplified) DMS Chinese (Simplified) 01/2019 Word No
F-00237H Appeal Request - MCOs - Care Wisconsin, Hmong DMS Hmong 01/2019 Word No
F-00237L Appeal Request - MCOs - Care Wisconsin, Laotian DMS Laotian 01/2019 Word No
F-00237SE Appeal Request - MCOs - Care Wisconsin, Serbo-Croatian DMS Serbian (Serbo-Croatian) 01/2019 Word No
F-00237SO Appeal Request - MCOs - Care Wisconsin, Somali DMS Somali 01/2019 Word No
F-00237S Appeal Request - MCOs - Care Wisconsin, Spanish DMS Spanish 01/2019 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.

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Last revised December 4, 2024