Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Title Division Other Location
F-02282A Resident Relocation Plan DMS
F-43005 Applicant Physician Assurance for J-1 Visa Waiver Applications DPH
F-00166 Service Delivery Discrimination Complaint DES
F-01578 Wisconsin’s Self-Directed IT System (WISITS) – Request For User Setup DMS
F-00309 Medicaid Provider Report DQA
F-20934 Court Ordered Assessment and Plan Report DCTS
F-20934A Plan Recommendation DCTS
F-20935 Status Report to Court for Plan Compliance DCTS
F-02230 County Agency Children's Community Option Program (CCOP) Annual Plan Update DMS
F-00115 Wisconsin Uniform Placement Criteria (WI-UPC) Adult Placement Scoring Instrument DCTS
F-00164 Civil Rights Compliance Plan OLC
F-05020 Paternity Order Due to Divorce - Judgment DPH
F-47472 Emergency Medical Technician (EMT) License / First Responder Certification Renewal Application DPH
F-00004A Health and Employment Counseling - I Think I Need More Time DMS
F-13158 Wisconsin Chronic Disease Program (WCDP) HIPAA Privacy Complaint DMS
F-13152 Wisconsin Medicaid HIPAA Privacy Complaint DMS
F-13166 Wisconsin SeniorCare HIPAA Privacy Complaint DMS
F-00169 Opting Out of Local Education Agency (LEA) and State Education Agency (SEA) Notification DMS
F-00657 Nurse Aide Training Program: Military Training Verification DQA
F-60820 Corporate Guardianship Program Status Application, Instructions and Checklist DQA
F-00596a PPS Mental Health Deskcard DCTS
F-01205B IRIS Participant Education: Budget Amendments DMS
F-01205J IRIS Participant Education: Self-Directed Personal Care DMS
F-02008 CLTS Waivers Certification Exam DMS
F-10161 Statement of Citizenship and/or Identity DMS
F-10129 Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application DMS
F-02339 Disaster Response Interpreter (DRI) Deployment Checklist for Community Shelters and Media Events DPH
F-00615A Change Project Summary and Instructions DPH
F-62588 Feeding Assistant Training Program Application DQA
F-62274A Personal Care Agency Consent for Home Visit DQA
F-00565A County Performance Plan (CPP) Goals DMS
F-02188 Lyme Disease Case Worksheet DPH
F-45019 Reciprocity Privileges Checklist DPH
F-02319 Home and Community-Based Waiver Medicaid Enrollment for the Children's Long-Term Support Waiver Program DMS
F-02284 Record of School Employee Examination DPH
F-47463C Intermediate Technician Operational Plan Components DPH
F-47463D Intermediate Operational Plan Components DPH
F-45023 Certificate - Use of Depleted Uranium under General License DPH
F-47463E Paramedic Operational Plan Components DPH
F-47482 EMT Training Center Certification Application DPH
F-47489 EMS Patient Care Worksheet DPH
F-47463A First Responder Operational Plan Components DPH
F-45020 Cumulative Occupational Exposure History DPH
F-47463B EMT - Basic Operational Plan Components DPH
F-00103 Wisconsin Blood Lead Registry User Security and Confidentiality Agreement DPH
F-00116 Wisconsin Blood Lead Registry Organization Security and Confidentiality Agreement DPH
F-44215 Child Care Center Report to the District Attorney DPH
F-44614B AIDS/HIV Drug Insurance Premium Subsidy Program and Drug Assistance Program Application/Recertification Part B - Physician Portion DPH
F-44001A Legal Notice: Required Immunizations for Admission to Wisconsin Child Care Centers DPH
F-44011 Application for Registration of Lead-Free or Lead-Safe Property DPH


Last Revised: March 23, 2021