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-10189 Undue Hardship Bed Hold Notice DMS
F-01626 OARS Facility Checklist DCTS
F-01624 OARS Alternative to Revocation (ATR) Referral DCTS
F-00944 Request for Approval: Comprehensive Community Services (CCS) Regional Service Model DCTS
F-02068 Request to Establish a Children's COP Risk Reserve DMS
F-01312 IRIS Provider Application DMS
F-01721 Instructions-Calculating CLTS Foster Care Room and Board Expenses DMS
F-01715 Calculating Expenses for a CLTS Foster Home Using Actual Expenses DMS
F-01716 Calculating Expenses for a CLTS Foster Home Using the Uniform Foster Care Brochure DMS
F-01477 Wisconsin Medicaid Program Nursing Home Cost Report Website User Request DMS
F-01319B IRIS Denial of Enrollment Request DMS
F-01319D IRIS Self-Directed Personal Care (SDPC) Involuntary Disenrollment Request DMS
F-02021 IRIS - Certified Public Accountant (CPA) Audit Checklist DMS
F-01314 IRIS Program Employment Checklist DMS
F-01319 IRIS Involuntary Disenrollment Request DMS
F-01310 IRIS Program Conflict of Interest Disclosure – Provider DMS
F-01310A IRIS Program Conflict of Interest Disclosure - Participant DMS
F-01549 IRIS Certification Designation of Confidential and Proprietary Information DMS
F-01558 Risk Agreement – IRIS Program DMS
F-01240 IRIS Critical Incident Reconciliation DMS
F-01210A IRIS Budget Amendment Provider Quote Comparison DMS
F-01206A IRIS One-Time Expense Vendor Bid Comparison DMS
F-01206B IRIS One-Time Expense Request - Ramp DMS
F-01213 Accessibility Assessment Request DMS
F-01207 IRIS Fiscal Employer Agent Quality Management Plan DMS
F-01208 IRIS Consultant Agency Quality Management Plan DMS
F-01209 IRIS Certification Acknowledgment DMS
F-01206 IRIS One-Time Expense Request DMS
F-01104 Specialized Psychiatric Rehabilitation Services (SPRS) Monthly Roster DMS
F-00052A Aging and Disability Resource Center (ADRC) Annual Budget DPH
F-01200 IRIS Program Cost Share Repayment Agreement DMS
F-00634A Types and Locations of Early Intervention Records Birth to 3 Program DMS
F-00915 Wisconsin Birth to 3 Program - Data Discussion Evaluation DMS
F-00915A Wisconsin Birth to 3 Program - Request for Data Discussion Certificate of Attendance DMS
F-00044 User Agreement for System Access DES
F-01588 Application for Available Beds DMS
F-01767 TEFAP Shelter Self-Assessment Tool DPH
F-01769 TEFAP Soup Kitchen Self-Assessment DPH
F-01930 Minority Health Advisory Group Nomination and Agreement DPH
F-62579 Post Survey Questionnaire DQA
F-00054A Request for Waiver of Requirements Relating to Co-Location of an ADRC and ICA/MCO or ADRC and Staff Subcontracted to an ICA/MCO DPH
F-01623 OARS - Residential Placement Reviews DCTS
F-01621 Smoking Cessation Data Collection DCTS
F-01625 OARS Participant Discharge Summary DCTS
F-01627 OARS Provider Case Manager Checklist DCTS
F-01336 Wisconsin Assessment of the Impaired Driver (WAID) and Other Substance Users DCTS
F-01761 Intoxicated Driver Program Self-Evaluation DCTS
F-01341 Pre-Release from Institution Checklist (CM Checklist) DCTS
F-01332 Predispositional Investigation Report (PDI) DCTS
F-01268 Application to Conduct Intoxicated Driver Assessments, Tribal Treatment Facility DCTS

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Last Revised: June 16, 2022