Skip to main content

Official DHS Forms Library

Temporary closure notice

The DHS forms and publications center is moving! To allow time for this move, we will not be processing any paper order requests October 9 through October 21. Any requests received during this time will be processed in the order they were received, beginning October 22.

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-10076ACM SeniorCare Application Instructions, Chinese (Simplified) DMS Chinese (Simplified) 04/2023 PDF No
F-10076AG SeniorCare Application Instructions, German DMS German 04/2023 PDF No
F-10076AH SeniorCare Application Instructions, Hmong DMS Hmong 04/2023 PDF No
F-10076AIT SeniorCare Application Instructions, Italian DMS Italian 04/2023 PDF No
F-10076AL SeniorCare Application Instructions, Laotian DMS Laotian 04/2023 PDF No
F-10076AP SeniorCare Application Instructions, Polish DMS Polish 04/2023 PDF No
F-10076AR SeniorCare Application Instructions, Russian DMS Russian 04/2023 PDF No
F-10076AS SeniorCare Application Instructions, Spanish DMS Spanish 04/2023 PDF No
F-10076H SeniorCare Application, Hmong DMS Hmong 03/2017 PDF No
F-10076L SeniorCare Application, Laotian DMS Laotian 03/2017 PDF No
F-10076S SeniorCare Application, Spanish DMS Spanish 03/2017 PDF No
F-10080 SeniorCare Authorization of Representative DMS English 07/2008 PDF No
F-01264 Service Fund Application DPH English 08/2024 PDF No
F-03346A Sexually Transmitted Infection and HIV Co-Infections Data Request DPH English 01/2025 HTML No
F-03346 Sexually Transmitted Infection Data Request DPH English 01/2025 HTML No
F-44243 Sexually Transmitted Infections Laboratory and Morbidity Case Report DPH English 01/2025 PDF No
F-02724A Short COVID-19 Contact Notification Information DPH English 10/2021 PDF No
F-02719A Short COVID-19 Initial Case Interview DPH English 09/2021 PDF No
F-62370 Significant Change in Health Screening Instrument Model Form DQA English 04/2009 PDF No
F-62370 Significant Change in Health Screening Instrument Model Form DQA English 04/2009 Word No
F-01621 Smoking Cessation Data Collection DCTS English 10/2016 Word No
F-16022 Social Security Number Referral DMS English 07/2008 PDF No
F-16022H Social Security Number Referral, Hmong DMS Hmong 07/2008 PDF No
F-16022S Social Security Number Referral, Spanish DMS Spanish 07/2008 PDF No
F-01345 Special Care Environment Working Document DPH English 09/2016 Word No
F-11296 Specialized Medical Vehicle (SMV) Transportation Service Informational OIG English 07/2012 PDF No
F-00885 Specialized Medical Vehicle Insurance Documentation Checklist DMS English 03/2014 PDF No
F-00885 Specialized Medical Vehicle Insurance Documentation Checklist DMS English 03/2014 Word No
F-11237 Specialized Medical Vehicle Providers Affidavit DMS English 01/2022 PDF No
F-11237 Specialized Medical Vehicle Providers Affidavit DMS English 01/2022 Word No
F-01050 Specialized Medical Vehicle Transportation Trip Ticket / Medical Care Verification DMS English 04/2022 PDF No
F-01050A Specialized Medical Vehicle Transportation Trip Ticket / Medical Care Verification Completion Instructions DMS English 04/2022 PDF No
F-01104 Specialized Psychiatric Rehabilitation Services (SPRS) Monthly Roster DMS English 02/2025 Excel No
F-01306 Spousal Impoverishment Income Allocation Worksheet DMS English 07/2014 PDF No
F-20812 SSI-E Natural Residential Setting Application Checklist DMS English 09/2019 PDF No
F-20812 SSI-E Natural Residential Setting Application Checklist DMS English 09/2019 Word No
F-11055 STAT-PA System Instructions DMS English 07/2015 PDF No
F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request DMS English 04/2017 PDF No
F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request DMS English 04/2017 Word No
F-00030A State and Specialty Maximum Allowed Cost Drug Pricing Review Request: Completion Instructions DMS English 04/2017 PDF No
F-00100 State Vital Records Birth Certificate Request Letter DMS English 06/2019 Word No
F-02430 Statement About Immigration Status DMS English 03/2019 PDF No
F-02430DA Statement About Immigration Status, Dari DMS Dari (Afghan Persian) 03/2019 PDF No
F-02430H Statement About Immigration Status, Hmong DMS Hmong 03/2019 PDF No
F-02430PA Statement About Immigration Status, Pashto DMS Pashto 03/2019 PDF No
F-02430S Statement About Immigration Status, Spanish DMS Spanish 03/2019 PDF No
F-02431 Statement About U.S. Military Service DMS English 06/2023 PDF No
F-02431AR Statement About U.S. Military Service, Arabic DMS Arabic 06/2023 PDF No
F-02431BU Statement About U.S. Military Service, Burmese DMS Burmese 06/2023 PDF No
F-02431CM Statement About U.S. Military Service, Chinese (Simplified) DMS Chinese (Simplified) 06/2023 PDF 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.

Glossary

 
Last revised August 28, 2025