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Official DHS 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 document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

Assigned number Title Division Language Release date File type Available to order
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 03/2025 PDF No
F-44017S Asbestos Application - Individual, Spanish DPH Spanish 03/2025 PDF No
F-00039 Asbestos Course Accreditation - Initial Application DPH English 09/2024 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 04/2025 Word No
F-00049S Asbestos Principal Instructor Application, Spanish DPH Spanish 04/2025 Word 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 Word 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-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-00286A Attestation to Administer Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections Completion Instructions DMS English 07/2015 PDF No
F-03369 Attestations of Compliance with Home and Community Based Service (HCBS) DOA English 03/2025 Word No
F-80479 Audit Confirmation Request DES English 10/2024 Word 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
F-22564 Authorization for Retroactive Caretaker Supplement (CTS) DMS English 07/2008 PDF No
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail DQA English 06/2013 PDF No
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail DQA English 06/2013 Word No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

Last revised December 4, 2024