Official DHS Forms Library

Temporary closure notice

The DHS forms and publications center is moving! To allow time for this move, we will not be processing any paper order requests October 9 through October 21. Any requests received during this time will be processed in the order they were received, beginning October 22.

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 Sort descending Division Language Release date File type Available to order
F-00004BH Health and Employment Counseling Employment Report, Hmong DMS Hmong 03/2025 PDF
F-00004BS Health and Employment Counseling Employment Report, Spanish DMS Spanish 03/2025 PDF
F-00004A Health and Employment Counseling Extension Request DMS English 02/2025 Word
F-00004AH Health and Employment Counseling Extension Request, Hmong DMS Hmong 02/2025 Word
F-00004AS Health and Employment Counseling Extension Request, Spanish DMS Spanish 02/2025 Word
F-43006 Health Care Employer Assurance for J-1 Visa Waiver Applications DPH English 10/2018 PDF
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 PDF
F-62494 Health Care Facility Construction Documentation Checklist DQA English 08/2020 Word
F-62500 Health Care Facility Fire Report DQA English 10/2018 HTML
F-03276 Health Information Exchange Patient Choice DCTS English 03/2024 PDF
F-01062 HealthCheck Adolescent Review DMS English 08/2019 Word
F-01062 HealthCheck Adolescent Review DMS English 08/2019 PDF
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 PDF
F-01062S HealthCheck Adolescent Review, Spanish DMS Spanish 08/2019 Word
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 Word
F-01066B HealthCheck Adolescent's Food Record (13 to 20 Years of Age) DMS English 07/2008 PDF
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 PDF
F-01066BS HealthCheck Adolescent's Food Record (13 to 20 Years of Age), Spanish DMS Spanish 07/2008 Word
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age DMS English 07/2008 PDF
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age DMS English 07/2008 Word
F-01066AS HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish DMS Spanish 07/2008 Word
F-01066AS HealthCheck Child's Food Record / 1 to 12 Years of Age, Spanish DMS Spanish 07/2008 PDF
F-11289 HealthCheck County Outreach Case Management Plan for County DMS English 09/2019 Word
F-11289 HealthCheck County Outreach Case Management Plan for County DMS English 09/2019 PDF
F-01063 HealthCheck Family History DMS English 08/2017 PDF
F-01063 HealthCheck Family History DMS English 08/2017 Word
F-01063S HealthCheck Family History, Spanish DMS Spanish 08/2017 PDF
F-01063S HealthCheck Family History, Spanish DMS Spanish 08/2017 Word
F-01002 HealthCheck Individual Health History DMS English 08/2019 Word
F-01002 HealthCheck Individual Health History DMS English 08/2019 PDF
F-01002H HealthCheck Individual Health History, Hmong DMS Hmong 08/2019 PDF
F-01002H HealthCheck Individual Health History, Hmong DMS Hmong 08/2019 Word
F-01002S HealthCheck Individual Health History, Spanish DMS Spanish 08/2019 PDF
F-01002S HealthCheck Individual Health History, Spanish DMS Spanish 08/2019 Word
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS English 07/2008 PDF
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS English 07/2008 Word
F-01066S HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish DMS Spanish 07/2008 Word
F-01066S HealthCheck Infant's Food Record (Birth to 12 Months of Age), Spanish DMS Spanish 07/2008 PDF
F-00021 HealthCheck Referral DMS English 01/2017 PDF
F-11285 HealthCheck Screener Affirmation OIG English 04/2022 PDF
F-11285 HealthCheck Screener Affirmation OIG English 04/2022 Word
F-01067 HealthCheck Your Child's Speech and Hearing DMS English 07/2008 PDF
F-01067 HealthCheck Your Child's Speech and Hearing DMS English 07/2008 Word
F-03004 Healthy Heart Ambassador Blood Pressure Self-Monitoring Program Exit Survey DPH English 03/2022 HTML
F-22554 Hearing Loss Certification Telecommunications Assistance Program (TAP) DPH English 08/2024 PDF
F-22554 Hearing Loss Certification Telecommunications Assistance Program (TAP) DPH English 08/2024 HTML
F-02242 Hepatitis A High-Risk Occupations Questionnaire DPH English 11/2017 PDF
F-02241 Hepatitis A Worksheet Confirmed and Suspected Cases DPH English 03/2018 PDF
F-13148 HIPAA Privacy Access Request DMS English 07/2008 PDF
F-13149 HIPAA Privacy Accounting Request DMS English 07/2008 PDF

Glossary

 
Last revised August 28, 2025