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-00390 Incident Report - Community Recovery Services (CRS) DCTS
F-00603 PPS (Program Participation System) Core Module DES
F-00315A Written Prior Notice - No Evaluation Recommended DMS
F-00052B Cares Data Access and Use Agreement / Designation of Cares Security and Data Exchange Coordinator DPH
F-00726 Typical Vision Developmental Milestones DMS
F-00295 Medical and Remedial Expenses Checklist for Medicaid Long-Term Care Waiver Programs DMS
F-00397 Consent to Use and Disclose Information for Multiple Registration/Continuity of Care DCTS
F-00727 Typical Hearing Developmental Milestones DMS
F-00301 2009 Wisconsin ACT 318 High Cost Mental Health Fund Application DCTS
F-00659 Substance Abuse Block Grant Prevention Program / Practice Approval DCTS
F-00479 Child Outcomes Fidelity Self-Assessment DMS
F-00615 Change Project Report and Instructions DPH
F-00315C Prior Notice and Consent for Evaluation and Assessment DMS
F-02528 Accreditation Mentoring Program - Mentor Application DPH
F-02529 Accreditation Mentoring Program - Mentee Application DPH
F-05102 Wisconsin Immunization Registry Opt-out Request DPH
F-02524 Agent Training Request DCTS
F-16035 Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) DMS
F-16036 Self-Employment Income Worksheet: Partnership (Schedule K-1 [Form 1065] and Form 1065) DMS
F-00191 Certified Outpatient Clinic: Request for a Branch Office DQA
F-00191A Certified Outpatient Clinic: Request for a School Branch Office DQA
F-02163 Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement DPH
F-00596 PPS Mental Health Module DCTS
F-00588 PPS Alcohol and Other Drug Abuse Module DCTS
F-00367B Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 12 Months DMS
F-00685 Statement of Tribal Affiliation DMS
F-00154 Wisconsin Consultative Examination Inquiry DMS
F-00098 Summary of Information Letter DMS
F-00356 Family Planning Only Services Authorization for Electronic Data Transfer of Application DMS
F-00100 State Vital Records Birth Certificate Request Letter DMS
F-00101 Authorization to Request Birth Records DMS
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information DMS
F-44771C Property Investigation Report / Case Management of Children with Elevated Blood Lead Levels DPH
F-02495 Vaccine for Adults (VFA) Provider Agreement DPH
F-02288 WisCaregiver Career Program: Registration Agreement DQA
F-00407 Financial Records Request DMS
F-20942A Total Expenses All Sources by Target Group and Standard Program Cluster Worksheet OPIB
F-42016 Authorization for Release of Confidential HIV Test Results DPH
F-02034 Aging/ADRC Integration Funding Budget Worksheet DPH
F-44118 WIC Vendor Application DPH
F-44322 Vendor / Participant Complaint - Wisconsin Women, Infant, and Children (WIC) Program DPH
F-05282 Wisconsin Divorce Certificate Application DPH
F-02117 Home and Community-Based Settings - Adult Residential Provider Assessment DMS
F-05260 Letter of Non-Marriage Application DPH
F-01309 IRIS Program Orientation and Enrollment Checklist DMS
F-62096A DQA Authority for Obtaining Provider Records Without Written Release DQA
F-13150 Wisconsin Medicaid Confidential or Alternative Communication Request DMS
F-44160A WIC Plastic Cover for WIC ID Folder (order in multiples of 200) DPH
F-01785 Letter - 40-Hour Health and Safety Assurance Policy Exception Request Denial DMS
F-01924 Public Comment on Rulemaking Project OLC

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Last Revised: June 16, 2022