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-00052C | Organizational Transition for Dementia Care Specialist | DPH | None |
| F-01697 | Application for Farmers Market or Direct Marketing Farmer EBT FoodShare Payment Processing Equipment | DMS | None |
| F-01578A | IRIS SharePoint - Request for User Setup | DMS | None |
| F-02658 | COVID-19 Testing | DQA | None |
| F-02331 | Caregiver Programs Customer Satisfaction Survey | DPH | None |
| F-80112 | Vendor Validation | DES | None |
| F-10112A | Medicaid – Disability Application Addendum | DMS | None |
| F-20891 | Intoxicated Driver Program Supplemental Funding Request | DCTS | None |
| F-02741 | Wisconsin Emergency Assistance Volunteer Registry (WEAVR): COVID-19 Staffing Request | DPH | None |
| F-02595 | Request for Approval: Youth Crisis Stabilization Facilities (YCSF) Certification Application | DCTS | None |
| F-02738 | Family Care Partnership Appeal Decision Letter | DMS | None |
| F-02739 | Family Care Partnership Letter about Your Right to Make a Fast Complaint | DMS | None |
| F-02737 | COVID Impact Survey for Behavioral Health Providers – Prep | DCTS | None |
| F-16076 | FoodShare Six-Month Report and Instructions | DMS | None |
| F-02734 | Nursing Home Notification of Intent to Use Asymptomatic, COVID Positive Staff | DQA | None |
| F-02461 | Tuberculosis (TB) Treatment Assistance Program - Special Request | DPH | None |
| F-04002 | School Report to Local Health Department | DPH | None |
| F-49357 | Personal Diabetes Care Record | DPH | Other |
| F-21343 | Alzheimer's Family and Caregiver Support Program (AFCSP) Budget Report | DPH | None |
| F-40034 | Wisconsin WIC Program Retail Vendor Initial Authorization Application and Instructions for Completing | DPH | None |
| F-11051 | Prior Authorization / Vision Services Attachment (PA/VA) | DMS | None |
| F-82009 | Confidential Information Release Authorization - Generic | DES | None |
| F-00136 | FoodShare Employment and Training (FSET) Program Participation Agreement | DMS | None |
| F-02651 | Nursing Home: COVID-19 Change Worksheet | DQA | None |
| F-02605A | HCBS Settings Rule: Heightened Scrutiny Settings Review – Evidentiary Document Checklist | DMS | None |
| F-02389 | Fall Medicare Training for Wisconsin Professionals | DPH | None |
| F-02382 | HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet | DMS | None |
| F-02725 | Application for COVID Connect Collection Site | OS | None |
| F-02726 | Hand Hygiene (HH) and Personal Protective Equipment (PPE) Observations | DPH | None |
| F-02530 | Application for Wisconsin's Test of English Proficiency (TEP) and Board for Examination of Interpreters (BEI) | DPH | None |
| F-40059 | The Emergency Food Assistance Program (TEFAP) Eligibility Certification | DPH | None |
| F-14014 | Authorization to Disclose Information to Disability Determination Bureau (DDB) | DMS | None |
| P-01391 | Mental Health Statistics Improvement Program (MHSIP) Adult Data Workbook | DCTS | None |
| F-01391A | Mental Health Statistics Improvement Program (MHSIP) Youth Data Workbook | DCTS | None |
| F-01391B | Mental Health Statistics Improvement Program (MHSIP) Family Data Workbook | DCTS | None |
| F-62333 | Plan Approval Application and Instructions | DQA | None |
| F-02715 | ADRC Client Tracking System Waiver Request | DPH | None |
| F-02714 | ADRC Professional Training Participant Survey | DPH | None |
| F-02716 | Authorization to Allocate Elder Benefit Specialist Funding to the Aging and Disability Resource Center | DPH | None |
| F-10187 | Divestment Penalty and Undue Hardship Notice | DMS | None |
| F-82009W | Confidential Information Release Authorization: Two Entities | OLC | None |
| F-02558 | Family Care Member County Notification | DMS | None |
| F-01389 | MHSIP Adult Satisfaction Survey | DCTS | None |
| F-00203 | Community Recovery Services (CRS) - County / Tribal Agency Application | DCTS | None |
| F-44016 | Asbestos Occupant Protection Plan | DPH | None |
| F-42000 | Vaccine Order | DPH | None |
| F-01673 | Prior Authorization/Preferred Drug List (PA/PDL) for Belsomra and Dayvigo | DMS | None |
| F-00330 | Request for Replacement FoodShare Benefits | DMS | None |
| F-01201 | IRIS Participant-Hired Worker Set-Up | DMS | None |
| F-13156 | Wisconsin Chronic Disease Program (WCDP) HIPAA Privacy Alternate Communication Request | DMS | None |
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Last Revised: March 23, 2021
