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-00390 | Incident Report - Community Recovery Services (CRS) | DCTS | None |
| F-00603 | PPS (Program Participation System) Core Module | DES | None |
| F-00315A | Written Prior Notice - No Evaluation Recommended | DMS | None |
| F-00052B | Cares Data Access and Use Agreement / Designation of Cares Security and Data Exchange Coordinator | DPH | None |
| F-00726 | Typical Vision Developmental Milestones | DMS | None |
| F-00295 | Medical and Remedial Expenses Checklist for Medicaid Long-Term Care Waiver Programs | DMS | None |
| F-00397 | Consent to Use and Disclose Information for Multiple Registration/Continuity of Care | DCTS | None |
| F-00727 | Typical Hearing Developmental Milestones | DMS | None |
| F-00301 | 2009 Wisconsin ACT 318 High Cost Mental Health Fund Application | DCTS | None |
| F-00659 | Substance Abuse Block Grant Prevention Program / Practice Approval | DCTS | None |
| F-00479 | Child Outcomes Fidelity Self-Assessment | DMS | None |
| F-00615 | Change Project Report and Instructions | DPH | None |
| F-00315C | Prior Notice and Consent for Evaluation and Assessment | DMS | None |
| F-02528 | Accreditation Mentoring Program - Mentor Application | DPH | None |
| F-02529 | Accreditation Mentoring Program - Mentee Application | DPH | None |
| F-05102 | Wisconsin Immunization Registry Opt-out Request | DPH | Other |
| F-02524 | Agent Training Request | DCTS | None |
| F-16035 | Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) | DMS | None |
| F-16036 | Self-Employment Income Worksheet: Partnership (Schedule K-1 [Form 1065] and Form 1065) | DMS | None |
| F-00191 | Certified Outpatient Clinic: Request for a Branch Office | DQA | None |
| F-00191A | Certified Outpatient Clinic: Request for a School Branch Office | DQA | None |
| F-02163 | Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement | DPH | None |
| F-00596 | PPS Mental Health Module | DCTS | None |
| F-00588 | PPS Alcohol and Other Drug Abuse Module | DCTS | None |
| F-00367B | Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 12 Months | DMS | None |
| F-00685 | Statement of Tribal Affiliation | DMS | None |
| F-00154 | Wisconsin Consultative Examination Inquiry | DMS | None |
| F-00098 | Summary of Information Letter | DMS | None |
| F-00356 | Family Planning Only Services Authorization for Electronic Data Transfer of Application | DMS | None |
| F-00100 | State Vital Records Birth Certificate Request Letter | DMS | None |
| F-00101 | Authorization to Request Birth Records | DMS | None |
| F-00246 | Employer Health Insurance Verification Individual Follow-Up Health Insurance Information | DMS | None |
| F-44771C | Property Investigation Report / Case Management of Children with Elevated Blood Lead Levels | DPH | None |
| F-02495 | Vaccine for Adults (VFA) Provider Agreement | DPH | None |
| F-02288 | WisCaregiver Career Program: Registration Agreement | DQA | None |
| F-00407 | Financial Records Request | DMS | None |
| F-20942A | Total Expenses All Sources by Target Group and Standard Program Cluster Worksheet | OPIB | None |
| F-42016 | Authorization for Release of Confidential HIV Test Results | DPH | None |
| F-02034 | Aging/ADRC Integration Funding Budget Worksheet | DPH | None |
| F-44118 | WIC Vendor Application | DPH | Other |
| F-44322 | Vendor / Participant Complaint - Wisconsin Women, Infant, and Children (WIC) Program | DPH | None |
| F-05282 | Wisconsin Divorce Certificate Application | DPH | None |
| F-02117 | Home and Community-Based Settings - Adult Residential Provider Assessment | DMS | None |
| F-05260 | Letter of Non-Marriage Application | DPH | None |
| F-01309 | IRIS Program Orientation and Enrollment Checklist | DMS | None |
| F-62096A | DQA Authority for Obtaining Provider Records Without Written Release | DQA | None |
| F-13150 | Wisconsin Medicaid Confidential or Alternative Communication Request | DMS | None |
| F-44160A | WIC Plastic Cover for WIC ID Folder (order in multiples of 200) | DPH | Other |
| F-01785 | Letter - 40-Hour Health and Safety Assurance Policy Exception Request Denial | DMS | None |
| F-01924 | Public Comment on Rulemaking Project | OLC | None |
Pages
Last Revised: June 16, 2022
