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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-62318 Hospice Quality Assessment and Performance Improvement Review DQA English 01/2024 PDF No
F-62318 Hospice Quality Assessment and Performance Improvement Review DQA English 01/2024 Word No
F-62320 Hospice Survey Information DQA English 03/2024 Word No
F-62319 Hospice Volunteer Program Review DQA English 01/2024 Word No
F-02527 Hospital (DHS 124), Home Health Agency (DHS 133), Hospice (DHS 131), Personal Care Agency (DHS 106), and Adult Day Care Center (DHS 105) DQA English 11/2022 Word No
F-62092 Hospital Certificate of Approval Application DQA English 03/2024 Word No
F-44725 Hospital/Clinic Supplement - Provider Participation Agreement DPH English 05/2019 Word No
F-00771A Hospitals State Vital Records Office (SVRO) Forms Requisition DPH English 06/2021 PDF No
F-22018 HSRS Long-Term Support Module - Module Type A DMS English 03/2017 Word No
F-22018 HSRS Long-Term Support Module - Module Type A DMS English 03/2017 PDF No
F-22018I HSRS Long-Term Support Module Desk Card DES English 03/2024 PDF No
F-22540 Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs OPIB English 01/2016 HTML No
F-22540A Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs Worksheet OS English 04/2013 Excel No
F-01570 Ice Arena Equipment Maintenance Log DPH English 06/2015 Word No
F-01572 Ice Arena Log of Pollutant Exceedance DPH English 06/2015 Word No
F-00195 IDEA (Individuals with Disabilities Education Act) State Complaint - WI Birth to 3 Program DMS English 12/2009 Word No
F-03161 ILSP Application DPH English 10/2023 PDF No
F-03161H ILSP Application, Hmong DPH Hmong 10/2023 PDF No
F-03161LP ILSP Application, Large Print DPH English 10/2023 PDF No
F-03161SO ILSP Application, Somali DPH Somali 10/2023 PDF No
F-03161S ILSP Application, Spanish DPH Spanish 10/2023 PDF No
F-03154B ILSP Non-Professional In-Home Service Provider And Individual Provider Attestation of Eligibility to Work DPH English 02/2024 PDF No
F-03154BH ILSP Non-Professional In-Home Service Provider And Individual Provider Attestation of Eligibility to Work, Hmong DPH Hmong 02/2024 PDF No
F-03154BSO ILSP Non-Professional In-Home Service Provider And Individual Provider Attestation of Eligibility to Work, Somali DPH Somali 02/2024 PDF No
F-03154BS ILSP Non-Professional In-Home Service Provider And Individual Provider Attestation of Eligibility to Work, Spanish DPH Spanish 02/2024 PDF No
F-03154 ILSP Non-Professional In-Home Service Provider Set-Up DPH English 02/2024 PDF No
F-03154H ILSP Non-Professional In-Home Service Provider Set-Up, Hmong DPH Hmong 02/2024 PDF No
F-03154LP ILSP Non-Professional In-Home Service Provider Set-Up, Large Print DPH English 02/2024 PDF No
F-03154SO ILSP Non-Professional In-Home Service Provider Set-Up, Somali DPH Somali 02/2024 PDF No
F-03154S ILSP Non-Professional In-Home Service Provider Set-Up, Spanish DPH Spanish 02/2024 PDF No
F-03154A ILSP Participant Acknowledgement of Non-Professional In-Home Service Provider and Individual Provider Eligibility DPH English 02/2024 PDF No
F-03154AH ILSP Participant Acknowledgement of Non-Professional In-Home Service Provider and Individual Provider Eligibility, Hmong DPH Hmong 02/2024 PDF No
F-03154ALP ILSP Participant Acknowledgement of Non-Professional In-Home Service Provider and Individual Provider Eligibility, Large Print DPH English 02/2024 PDF No
F-03154ASO ILSP Participant Acknowledgement of Non-Professional In-Home Service Provider and Individual Provider Eligibility, Somali DPH Somali 02/2024 PDF No
F-03154AS ILSP Participant Acknowledgement of Non-Professional In-Home Service Provider and Individual Provider Eligibility, Spanish DPH Spanish 02/2024 PDF No
F-03160 ILSP Participant Disenrollment DPH English 04/2024 PDF No
F-03160LP ILSP Participant Disenrollment (Large Print) DPH English 04/2024 PDF No
F-03160H ILSP Participant Disenrollment, Hmong DPH Hmong 04/2024 PDF No
F-03160SO ILSP Participant Disenrollment, Somali DPH Somali 04/2024 PDF No
F-03160S ILSP Participant Disenrollment, Spanish DPH Spanish 04/2024 PDF No
F-03159 ILSP Post-Pilot Survey DPH English 05/2023 PDF No
F-03159 ILSP Post-Pilot Survey DPH English 05/2023 HTML No
F-03159H ILSP Post-Pilot Survey, Hmong DPH Hmong 05/2023 PDF No
F-03159LP ILSP Post-Pilot Survey, Large Print DPH English 05/2023 PDF No
F-03159SO ILSP Post-Pilot Survey, Somali DPH Somali 05/2023 PDF No
F-03159S ILSP Post-Pilot Survey, Spanish DPH Spanish 05/2023 PDF No
F-03158 ILSP Pre-Pilot Survey DPH English 05/2023 PDF No
F-03158H ILSP Pre-Pilot Survey, Hmong DPH Hmong 05/2023 PDF No
F-03158LP ILSP Pre-Pilot Survey, Large Print DPH English 05/2023 PDF No
F-03158SO ILSP Pre-Pilot Survey, Somali DPH Somali 05/2023 PDF 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