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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-00258 Functional Eligibility Screen - Mental Health and Substance Use Disorder Services DCTS English 03/2023 PDF No
F-00367 Functional Eligibility Screen for Children's Long-Term Support Programs (PDF, 122 KB) DMS English 12/2021 PDF No
F-00726 Functional Vision Screening Tool: Children 0 to 3 Years of Age DMS English 10/2024 Word No
F-00165C Funded Programs Checklist OLC English 12/2021 Word No
F-00165B Funding Relationship to DHS/DCF OLC English 12/2021 Word No
F-80112 GEARS Agency Set-up DES English 10/2023 Word No
F-01068F General Pediatric Clinic - 12 Month Visit DMS English 08/2019 PDF No
F-01068F General Pediatric Clinic - 12 Month Visit DMS English 08/2019 Word No
F-01068G General Pediatric Clinic - 15 Month Visit DMS English 08/2019 Word No
F-01068G General Pediatric Clinic - 15 Month Visit DMS English 08/2019 PDF No
F-01068H General Pediatric Clinic - 18 Month Visit DMS English 08/2019 Word No
F-01068H General Pediatric Clinic - 18 Month Visit DMS English 08/2019 PDF No
F-01068I General Pediatric Clinic - 24 Month Visit DMS English 08/2019 Word No
F-01068I General Pediatric Clinic - 24 Month Visit DMS English 08/2019 PDF No
F-01068A General Pediatric Clinic - 3 to 4 Week Visit DMS English 08/2019 PDF No
F-01068A General Pediatric Clinic - 3 to 4 Week Visit DMS English 08/2019 Word No
F-01068C General Pediatric Clinic - 4 Month Visit DMS English 08/2019 Word No
F-01068C General Pediatric Clinic - 4 Month Visit DMS English 08/2019 PDF No
F-01068D General Pediatric Clinic - 6 Month Visit DMS English 08/2019 PDF No
F-01068D General Pediatric Clinic - 6 Month Visit DMS English 08/2019 Word No
F-01068B General Pediatric Clinic - 6 to 8 Week Visit DMS English 08/2019 Word No
F-01068B General Pediatric Clinic - 6 to 8 Week Visit DMS English 08/2019 PDF No
F-01068E General Pediatric Clinic - 9 Month Visit DMS English 08/2019 Word No
F-01068E General Pediatric Clinic - 9 Month Visit DMS English 08/2019 PDF No
F-01068K General Pediatric Clinic - Elementary School Visit DMS English 08/2019 PDF No
F-01068K General Pediatric Clinic - Elementary School Visit DMS English 08/2019 Word No
F-01068J General Pediatric Clinic - Preschool Visit DMS English 08/2019 Word No
F-01068J General Pediatric Clinic - Preschool Visit DMS English 08/2019 PDF No
F-01068L General Pediatric Clinic - Teenager Visit DMS English 08/2019 PDF No
F-01068L General Pediatric Clinic - Teenager Visit DMS English 08/2019 Word No
F-45021 Generally Licensed Device Inspection by Mail DPH English 03/2010 PDF No
F-45021 Generally Licensed Device Inspection by Mail DPH English 03/2010 Word No
F-10111 Good Faith Medicaid / BadgerCare Plus Certification DMS English 09/2013 PDF No
F-10111A Good Faith Medicaid / BadgerCare Plus Certification Instructions DMS English 09/2013 PDF No
F-00642 Grants Enrollment, Application & Reporting System (GEARS) Expenditure Report DES English 03/2025 Excel No
F-01212 Grievance - IRIS Program DMS English 03/2025 Word No
F-01212FR Grievance - IRIS Program, French DMS French 03/2025 Word No
F-02726 Hand Hygiene (HH) and Personal Protective Equipment (PPE) Observations DPH English 10/2020 PDF No
F-02475 Hand Hygiene Observations DPH English 06/2021 PDF No
F-03227 Harm Reduction Response Team Outreach Efforts DPH English 09/2023 HTML No
F-02989 Hazard Assessment Section Presentation Feedback DPH English 03/2022 HTML No
F-03288A HCBS 100% Community-Based Non-Residential Provider Attestation DMS English 06/2024 Word No
F-02382 HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet DMS English 10/2018 Word No
F-02383 HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary DMS English 12/2020 Word No
F-02383C HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - 3-4 AFH DMS English 01/2021 Word No
F-02383A HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - CBRF DMS English 05/2024 Word No
F-02383B HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary - RCAC DMS English 05/2024 Word No
F-02605A HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist DMS English 09/2022 Word No
F-02605AI HCBS Settings Rule: Heightened Scrutiny Settings Review - Evidentiary Document Checklist, Instructions DMS English 09/2022 PDF No
F-00004 Health and Employment Counseling Application DMS English 02/2025 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 December 4, 2024