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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-10126AL Appoint, Change, or Remove an Authorized Representative: Person, Laotian DMS Laotian 03/2024 PDF No
F-10126APA Appoint, Change, or Remove an Authorized Representative: Person, Pashto DMS Pashto 03/2024 PDF No
F-10126AR Appoint, Change, or Remove an Authorized Representative: Person, Russian DMS Russian 03/2024 PDF No
F-10126ASO Appoint, Change, or Remove an Authorized Representative: Person, Somali DMS Somali 03/2024 PDF No
F-10126AS Appoint, Change, or Remove an Authorized Representative: Person, Spanish DMS Spanish 03/2024 PDF No
F-22599 Appointment of Authorized Representative for Supplemental Security Income (SSI) DMS English 07/2008 PDF No
F-01804 Appointment Results Wisconsin WIC Program DPH English 02/2018 Word No
F-02052 Asbestos Abatement Project Log DPH English 03/2017 PDF No
F-44017 Asbestos Application - Individual DPH English 11/2023 PDF No
F-44017S Asbestos Application - Individual, Spanish DPH Spanish 11/2023 PDF No
F-44002 Asbestos Company Application DPH English 05/2021 PDF No
F-44002S Asbestos Company Application, Spanish DPH Spanish 05/2021 PDF No
F-00039 Asbestos Course Accreditation - Initial DPH English 03/2009 PDF No
F-00040 Asbestos Course Accreditation - Renewal DPH English 05/2024 Word No
F-03295D Asbestos Course Test Policy Description DPH English 07/2024 Word No
F-44016 Asbestos Occupant Protection Plan DPH English 09/2020 PDF No
F-00049 Asbestos Principal Instructor Application DPH English 04/2022 PDF No
F-00041 Asbestos Project Notification DPH English 05/2024 PDF No
F-03295B Asbestos Quality Control Plan DPH English 07/2024 Word No
F-03295A Asbestos Recordkeeping Description DPH English 07/2024 Word No
F-03295 Asbestos Student Admissions Plan DPH English 07/2024 Word No
F-03295C Asbestos Training Resource Description DPH English 07/2024 Word No
F-20817 Assessment Worksheet for Natural Residential Setting DMS English 09/2019 Word No
F-20817 Assessment Worksheet for Natural Residential Setting DMS English 09/2019 PDF No
F-20817A Assessment Worksheet for Natural Residential Setting - for Individuals with Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses DMS English 09/2019 PDF No
F-20817A Assessment Worksheet for Natural Residential Setting - for Individuals with Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses DMS English 09/2019 Word No
F-20817S Assessment Worksheet for Natural Residential Setting, Spanish DMS Spanish 08/2008 PDF No
F-02111 Assisted Living - Fit and Qualified Application for Community-Based Residential Facilities, Adult Family Homes and Adult Day Care Centers DQA English 12/2021 Word No
F-03265 Assisted Living Administrator Notification DQA English 01/2024 Word No
F-02208 Assisted Living Facility Self-Report DQA English 05/2024 Word No
F-62548 Assisted Living Facility Waiver, Approval, Variance, or Exception Request DQA English 05/2023 PDF No
F-62548 Assisted Living Facility Waiver, Approval, Variance, or Exception Request DQA English 05/2023 Word No
F-01408 Asthma Control Summary DPH English 07/2022 PDF No
F-01408S Asthma Control Summary, Spanish DPH Spanish 07/2022 PDF No
F-01414 Asthma-Safe Homes Program Participant Satisfaction Survey DPH English 04/2023 HTML No
F-01414 Asthma-Safe Homes Program Participant Satisfaction Survey DPH English 01/2023 Word No
F-01414S Asthma-Safe Homes Program Participant Satisfaction Survey, Spanish DPH Spanish 01/2023 Word No
F-03072 Asthma-Safe Homes Program Referral DPH English 07/2022 PDF No
F-02805 Attestation for Use of Standing Prescription Order (Dr. Ryan Westergaard, Chief Medical Officer and State Epidemiologist), for trained personnel to collect and/or analyze specimens for COVID-19 testing DPH English 05/2021 PDF No
F-00286 Attestation to Administer Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections DMS English 04/2014 PDF No
F-00286 Attestation to Administer Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections DMS English 04/2014 Word No
F-80479 Audit Confirmation Request DES English 01/2013 Word No
F-80479 Audit Confirmation Request DES English 01/2013 PDF No
F-40057 Authorization and Permission For Release of Information to Wisconsin Birth Defects Prevention and Surveillance System and Early Childhood Program DPH English 12/2003 PDF No
F-00340 Authorization and Release - Photograph, Video, and/or Audio Recording OS English 06/2016 PDF No
F-00086 Authorization for Final Disposition DPH English 08/2008 HTML No
F-22565 Authorization for Recoupment Caretaker Supplement DMS English 09/2019 Word No
F-22565 Authorization for Recoupment Caretaker Supplement (CTS) DMS English 09/2019 PDF No
F-42016 Authorization for Release of Confidential HIV Test Results DPH English 02/2019 PDF No
F-42016S Authorization for Release of Confidential HIV Test Results, Spanish DPH Spanish 02/2019 PDF No

Glossary

 
Last revised December 8, 2023