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Data Collection (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 form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-02074A Instructions: Medicare Other Coverage Discrepancy Report DMS English 04/2018 PDF No
F-11133A Instructions: Personal Care Screening Tool (PCST) DMS English 08/2017 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 05/2019 PDF No
F-01248A Instructions: Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business DMS English 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Chinese Mandarin DMS Chinese Mandarin 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Hmong DMS Hmong 06/2019 PDF No
F-00219 Instructions: Self-Employment Income Report: Farm Business, Spanish DMS Spanish 06/2019 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 09/2023 Word No
F-02961 Introduction to Community Recovery Services Presentation Evaluation Survey DCTS English 02/2022 HTML No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization DPH English 02/2024 Word No
F-00075 IRIS (Include, Respect, I Self-Direct) Authorization (DocuSign) DPH English 02/2024 HTML No
F-00075LP IRIS (Include, Respect, I Self-Direct) Authorization (Large Print) DPH English 02/2024 Word No
F-00075AR IRIS (Include, Respect, I Self-Direct) Authorization, Arabic DPH Arabic 02/2024 PDF No
F-00075CM IRIS (Include, Respect, I Self-Direct) Authorization, Chinese (Mandarin) DPH Chinese Mandarin 02/2024 Word No
F-00075H IRIS (Include, Respect, I Self-Direct) Authorization, Hmong DPH Hmong 02/2024 Word No
F-00075L IRIS (Include, Respect, I Self-Direct) Authorization, Laotian DPH Laotian 02/2024 Word No
F-00075R IRIS (Include, Respect, I Self-Direct) Authorization, Russian DPH Russian 02/2024 Word No
F-00075SE IRIS (Include, Respect, I Self-Direct) Authorization, Serbo-Croatian DPH Serbian (Serbo-Croatian) 02/2024 Word No
F-00075SO IRIS (Include, Respect, I Self-Direct) Authorization, Somali DPH Somali 02/2024 Word No
F-00075S IRIS (Include, Respect, I Self-Direct) Authorization, Spanish DPH Spanish 02/2024 Word No
F-02021 IRIS - Certified Public Accountant (CPA) Audit Checklist DMS English 02/2017 Word No
F-01210A IRIS Budget Amendment Provider Quote Comparison DMS English 02/2017 Word No
F-01210 IRIS Budget Amendment Request DMS English 12/2017 Word No
F-01209 IRIS Certification Acknowledgment DMS English 02/2017 Word No
F-01549 IRIS Certification Designation of Confidential and Proprietary Information DMS English 02/2017 Word No
F-01208A IRIS Consultant Agency (ICA) Quality Management Plan DMS English 12/2023 Excel No
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist DMS English 08/2020 Word No
F-01208 IRIS Contractor Quality Management Plan - Attachment Cover Sheet DMS English 09/2023 Word No
F-01240 IRIS Critical Incident Reconciliation DMS English 02/2017 Word No
F-01319B IRIS Denial of Enrollment Request DMS English 02/2017 Word No
F-03117 IRIS Electronic Visit Verification (EVV) System or Power Outage Exception Notification DMS English 12/2022 Word No
F-02914 IRIS Electronic Visit Verification Risk Agreement DMS English 06/2023 Word No
F-02046 IRIS Financial Projections Template DMS English 06/2021 Excel No
F-02047 IRIS Financial Reporting DMS English 02/2024 Excel No
F-01208B IRIS Fiscal Employer Agent (FEA) Quality Management Plan DMS English 01/2024 Excel No
F-01319 IRIS Involuntary Disenrollment Request DMS English 02/2017 Word No
F-02488 IRIS Monthly Rate of Service (MROS) Discrepancy Resolution DMS English 02/2022 Excel No
F-02470 IRIS Noncompliance Statement and Corrective Action Plan DMS English 03/2019 Word No
F-01206 IRIS One-Time Expense Request DMS English 02/2017 Word No
F-01206B IRIS One-Time Expense Request - Ramp DMS English 02/2017 Word No
Last revised December 8, 2023