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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-02466AI Instructions for Logging MCO Grievances DMS English 12/2022 PDF No
F-00232I Instructions for Notice of Adverse Benefit Determination (Notice of Action) DMS English 12/2021 PDF No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 PDF No
F-62022A Instructions for Report of Hours Worked and Resident Census Forms DQA English 02/2009 Word No
F-00539 Instructions for the County Waiver Agency Support and Service Coordination (SSC) Rates DMS English 09/2019 PDF No
F-00202I Instructions – Individual Service Plan – Community Recovery Services (CRS) DCTS English 08/2016 PDF No
F-00107 Instructions, Self-Employment Income Report DMS English 06/2019 PDF No
F-00107ACM Instructions, Self-Employment Income Report, Chinese (Simplified) DMS Chinese (Simplified) 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Hmong DMS Hmong 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Spanish DMS Spanish 06/2019 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records DMS English 02/2017 PDF No
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish DMS Spanish 02/2017 PDF No
F-02717A Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification DMS English 04/2023 PDF No
F-02717AH Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong DMS Hmong 04/2023 PDF No
F-02717AS Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish DMS Spanish 04/2023 PDF No
F-01234A Instructions: Explanation of Medical Benefits DMS English 11/2023 PDF No
F-16030B Instructions: FoodShare Wisconsin Overpayment Calculator DMS English 01/2018 PDF No
F-02382I Instructions: HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet DMS English 10/2020 PDF No
F-44614I Instructions: HIV Drug Assistance Program and Insurance Assistance Program Application/Recertification DPH English 12/2025 PDF No
F-44614IS Instructions: HIV Drug Assistance Program and Insurance Assistance Program Application/Recertification, Spanish DPH Spanish 12/2025 PDF No
F-02074A Instructions: Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF No
F-11010A Instructions: Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2018 PDF No
F-11008A Instructions: Prior Authorization / Therapy Attachment (PA/TA) DMS English 04/2025 PDF No
F-01248A Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF No
F-22637 Interagency Notification -Termination of Community Waiver Participation DMS English 03/2017 PDF No
F-10142 Interagency Notification of Termination of Medicaid Waiver Eligibility for a Community Waiver Participant DMS English 07/2008 PDF No
F-42010 Interjurisdictional Tuberculosis Notification DPH English 03/2003 PDF No
F-42011 Interjurisdictional Tuberculosis Notification - Follow-up DPH English 03/2003 PDF No
F-47463D Intermediate Operational Plan Components DPH English 06/2012 PDF No
F-47463C Intermediate Technician Operational Plan Components DPH English 06/2012 PDF No
F-03010 Intoxicated Driver Program Assessor Training Application DCTS English 03/2022 HTML No
F-01761 Intoxicated Driver Program Self-Evaluation DCTS English 09/2016 Word No
F-20891 Intoxicated Driver Program Supplemental Funding Request DCTS English 09/2025 Word No
F-02961 Introduction to Community Recovery Services Presentation Evaluation Survey DCTS English 02/2022 HTML No
F-02764 IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal DPH English 12/2025 Word No
F-02764 IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal (DocuSign) DPH English 12/2025 HTML No
F-02764AR IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Arabic DPH Arabic 12/2025 Word No
F-02764AR IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Arabic (DocuSign) DPH Arabic 12/2025 HTML No
F-02764BU IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Burmese DPH Burmese 12/2025 Word No
F-02764BU IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Burmese (DocuSign) DPH Burmese 12/2025 HTML No
F-02764CM IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Chinese (Simplified) DPH Chinese (Simplified) 12/2025 Word No
F-02764CM IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Chinese (Simplified) (DocuSign) DPH Chinese (Simplified) 12/2025 HTML No
F-02764H IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Hmong DPH Hmong 12/2025 Word No
F-02764H IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Hmong (DocuSign) DPH Hmong 12/2025 HTML No
F-02764L IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Laotian DPH Lao 12/2025 Word No
F-02764L IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Laotian (DocuSign) DPH Lao 12/2025 HTML No
F-02764R IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Russian DPH Russian 12/2025 Word No
F-02764R IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Russian (DocuSign) DPH Russian 12/2025 HTML No
F-02764SO IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Somali DPH Somali 12/2025 Word No
F-02764SO IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) — Transfer Request or Withdrawal, Somali (DocuSign) DPH Somali 12/2025 HTML 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 October 27, 2025