Skip to main content
Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

HTTPS

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

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-21076 Informed Consent – Children's Long-Term Support Functional Screen DMS English 03/2021 Word No
F-21076 Informed Consent – Children's Long-Term Support Functional Screen, Karen DMS Karen 03/2021 PDF No
F-21076 Informed Consent – Children's Long-Term Support Functional Screen, Rohingya DMS Rohingya 03/2021 Word No
F-21076 Informed Consent – Children's Long-Term Support Functional Screen, Somali DMS Somali 03/2021 Word No
F-02031 Initial Application - Individual Lead Disciplines, Spanish DPH Spanish 03/2023 PDF No
F-03082C Initial Certification Application for Branch Office or School Branch Office DQA English 08/2022 Word No
F-03082F Initial Certification Application for DHS 75.59 Opioid Treatment Program (OTP) Medication Unit, Mobile Medication Unit, or Mobile OTP Unit DQA English 11/2022 Word No
F-03082 Initial Certification or Change of Ownership Application for DHS 75.14 and DHS 75.15 Service Certification DQA English 08/2022 Word No
F-03082A Initial Certification or Change of Ownership Application for DHS 75.49, DHS 75.50, DHS 75.51, and DHS 75.52 Service Certification DQA English 08/2022 Word No
F-03082E Initial Certification or Change of Ownership Application for DHS 75.53-DHS 75.58 Service Certification DQA English 09/2022 Word No
F-03082B Initial Certification or Change of Ownership Application for DHS 75.59 Service Certification DQA English 08/2022 Word No
F-03082D Initial Certification or Change of Ownership Application for DHS 75.60 Service Certification DQA English 08/2022 Word No
F-47463J Initial EMS Service Providers Operational Plan Components Checklist DPH English 09/2022 Word No
F-02996 Initial Lead Abatement Certification Application DPH English 03/2022 PDF No
F-02031 Initial Lead Application - Individual Certification DPH English 03/2023 PDF No
F-10097 Institutional Medicaid Income Allocation DMS English 06/2022 PDF No
F-10097 Institutional Medicaid Income Allocation, Hmong DMS Hmong 06/2022 PDF No
F-10097 Institutional Medicaid Income Allocation, Spanish DMS Spanish 06/2022 PDF No
F-00286 Instructions DMS English 07/2015 PDF No
F-01188 Instructions DMS English 02/2020 PDF No
F-11040 Instructions DMS English 12/2019 PDF No
F-00556 Instructions DMS English 01/2018 PDF No
F-80112 Instructions DES English 06/2008 PDF No
F-20942A Instructions OPIB English 05/2019 PDF No
F-01187 Instructions DMS English 02/2018 PDF No
F-00162 Instructions DMS English 05/2020 PDF No
F-00950 Instructions DMS English 10/2022 PDF No
F-11079 Instructions DMS English 07/2017 PDF No
F-02382 Instructions DMS English 10/2020 PDF No
F-00232 Instructions DMS English 12/2021 PDF No
F-01189 Instructions DMS English 02/2020 PDF No
F-11136 Instructions DMS English 10/2008 PDF No
F-00202 Instructions (PDF, 177 KB) DCTS English 08/2016 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint OLC English 08/2018 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint, Hmong OLC Hmong 08/2018 PDF No
F-80983 Instructions - Completing the Civil Rights Complaint, Spanish OLC Spanish 08/2018 PDF No
F-00989i Instructions for Completing Wisconsin's Individualized Family Service Plan (IFSP) DMS English 03/2017 PDF No
F-03112 Instructions for Logging HMO Appeals DMS English 12/2022 PDF No
F-02466 Instructions for Logging MCO Appeals DMS English 12/2022 PDF No
F-02466A Instructions for Logging MCO Grievances DMS English 12/2022 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-44623 Instructions for WIC Time Study and Non-WIC Time Study DPH English 06/2020 PDF No
F-20582 Instructions, English DMS English 03/2023 PDF No
F-20582 Instructions, Hmong DMS Hmong 03/2023 PDF No
F-00107 Instructions, Self-Employment Income Report DMS English 06/2019 PDF No
F-00107 Instructions, Self-Employment Income Report, Chinese Mandarin DMS Chinese Mandarin 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
Last revised April 13, 2023