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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-44000 Tuberculosis Disease Initial Request for Medication DPH English 11/2021 PDF No
F-00905 Tuberculosis Infection - Initial Request for Medication DPH English 02/2023 Word No
F-02163 Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement DPH English 06/2019 PDF No
F-42001 Tuberculosis Suspect Case Data DPH English 04/2001 PDF No
F-03107 Tuberculosis Uniting for Ukraine (U4U) Assistance Program Enrollment and Agreement DPH English 01/2023 Word No
F-03108 Tuberculosis Uniting for Ukraine (U4U) Assistance Program Request for Reimbursement DPH English 01/2023 Word No
F-03109 Tuberculosis Uniting for Ukraine (U4U) Assistance Program Special Request DPH English 01/2023 Word No
F-00634A Types and Locations of Early Intervention Records Birth to 3 Program DMS English 02/2017 Word No
F-00727 Typical Hearing Developmental Milestones DMS English 02/2017 Word No
F-00726 Typical Vision Developmental Milestones DMS English 02/2017 Word No
F-10189 Undue Hardship Bed Hold Notice DMS English 04/2017 Word No
F-10188 Undue Hardship Waiver Decision for Facility DMS English 04/2017 Word No
F-03135 Update to an EMS Service Providers Operational Plan Components Checklist DPH English 03/2023 Word No
F-02140 Urgent Services Agreement DPH English 05/2023 Word No
F-02140 Urgent Services Agreement DPH 05/2023 HTML No
F-02140AR Urgent Services Agreement, Arabic DPH Arabic 05/2023 Word No
F-02140CM Urgent Services Agreement, Chinese (Mandarin) DPH Chinese Mandarin 05/2023 Word No
F-02140H Urgent Services Agreement, Hmong DPH Hmong 05/2023 Word No
F-02140L Urgent Services Agreement, Laotian DPH Laotian 05/2023 Word No
F-02140LP Urgent Services Agreement, Large Print DPH English 05/2023 Word No
F-02140R Urgent Services Agreement, Russian DPH Russian 05/2023 Word No
F-02140SE Urgent Services Agreement, Serbo-Croatian DPH Serbian (Serbo-Croatian) 05/2023 Word No
F-02140SO Urgent Services Agreement, Somali DPH Somali 05/2023 Word No
F-02140S Urgent Services Agreement, Spanish DPH Spanish 05/2023 Word No
F-00044 User Agreement for System Access DES English 01/2017 Word No
F-02995 Vaccination Community Outreach Grant Quarterly Report DPH 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 10/2010 PDF Yes
F-44702S Vaccine Administration Record, Spanish DPH Spanish 10/2010 PDF Yes
F-02495 Vaccine for Adults (VFA) and Bridge Access Program (BAP) Provider Agreement DPH English 08/2023 PDF No
F-02502 Vaccine for Adults (VFA) Community Outreach DPH English 04/2022 PDF No
F-02503 Vaccine for Outbreak Response Request DPH English 08/2019 PDF No
F-01744 Vaccine Restitution Policy - Agreement DPH English 01/2023 PDF No
F-02287 Vaccine Return - Request for Authorization to Return DPH English 12/2017 PDF No
F-21059 Variance Request for Institution Respite DMS English 03/2017 PDF No
F-21059 Variance Request for Institution Respite DMS English 03/2017 Word No
F-44322 Vendor / Participant Complaint - Wisconsin Women, Infant, and Children (WIC) Program DPH English 03/2018 PDF No
F-04003 Vendor Monitoring Site Visit Report Wisconsin: WIC Program DPH English 10/2021 PDF No
F-02919 Vendor Performance Report for Division of Medicaid Services (DMS) DMS English 01/2023 Word No
F-80112 Vendor Validation DES English 06/2018 Word No
F-02622 Vendor/Participant Complaint: Wisconsin WIC and Senior Farmers' Market Nutrition Program (FMNP) DPH English 03/2023 Word No
F-01017 Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement DMS English 08/2019 Word No
F-01017 Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement DMS English 08/2019 PDF No
F-10162 Verification of Veterans Benefits DMS English 12/2022 PDF No
F-02193 Verifying Tax-Exempt Income for Live-In Care Providers DMS English 06/2023 PDF No
F-05283 Veteran's and Veteran's Dependent's Request for Certified Copy of a Wisconsin Vital Record DPH English 10/2017 PDF Yes
F-02329 VFC Change of Information DPH English 05/2023 PDF No
F-01394 Virginia Graeme Baker Act - Drain Cover Replacement Log DPH English 12/2014 PDF No
F-02520 Voluntarily Declining Benefits DMS English 01/2023 PDF No
F-00335 Voluntary Agreement for Crisis Stabilization Services DCTS English 03/2017 Word No
F-05024 Voluntary Paternity Acknowledgement DPH English 05/2016 Paper Yes
Last revised July 18, 2023