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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-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-02140CM Urgent Services Agreement, Chinese (Simplified) DPH Chinese (Simplified) 12/2025 Word No
F-02140H Urgent Services Agreement, Hmong DPH Hmong 12/2025 Word No
F-02140L Urgent Services Agreement, Laotian DPH Lao 12/2025 Word No
F-02140R Urgent Services Agreement, Russian DPH Russian 12/2025 Word No
F-02140SO Urgent Services Agreement, Somali DPH Somali 12/2025 Word No
F-02140S Urgent Services Agreement, Spanish DPH Spanish 12/2025 Word No
F-02140UK Urgent Services Agreement, Ukrainian DPH Ukrainian 12/2025 Word No
F-02140V Urgent Services Agreement, Vietnamese DPH Vietnamese 12/2025 Word No
F-02140 Urgent Services Enrollment Agreement DPH English 12/2025 Word No
F-02140 Urgent Services Enrollment Agreement (DocuSign) DPH English 12/2025 HTML No
F-02140AR Urgent Services Enrollment Agreement, Arabic DPH Arabic 12/2025 Word No
F-02140AR Urgent Services Enrollment Agreement, Arabic (DocuSign) DPH Arabic 12/2025 HTML No
F-02140BU Urgent Services Enrollment Agreement, Burmese DPH Burmese 12/2025 Word No
F-02140BU Urgent Services Enrollment Agreement, Burmese (DocuSign) DPH Burmese 12/2025 HTML No
F-02140CM Urgent Services Enrollment Agreement, Chinese (Simplified) (DocuSign) DPH Chinese (Simplified) 12/2025 HTML No
F-02140H Urgent Services Enrollment Agreement, Hmong (DocuSign) DPH Hmong 12/2025 HTML No
F-02140L Urgent Services Enrollment Agreement, Laotian (DocuSign) DPH Lao 12/2025 HTML No
F-02140R Urgent Services Enrollment Agreement, Russian (DocuSign) DPH Russian 12/2025 Word No
F-02140SO Urgent Services Enrollment Agreement, Somali (DocuSign) DPH Somali 12/2025 HTML No
F-02140S Urgent Services Enrollment Agreement, Spanish (DocuSign) DPH Spanish 12/2025 HTML No
F-02140UK Urgent Services Enrollment Agreement, Ukrainian (DocuSign) DPH Ukrainian 12/2025 HTML No
F-02140V Urgent Services Enrollment Agreement, Vietnamese (DocuSign) DPH Vietnamese 12/2025 HTML No
F-00044 User Agreement for System Access DES English 01/2017 Word No
F-02995 Vaccination Community Outreach Grant Quarterly Report DPH English 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 04/2025 PDF No
F-44702H Vaccine Administration Record, Hmong DPH Hmong 04/2025 PDF No
F-44702S Vaccine Administration Record, Spanish DPH Spanish 04/2025 PDF No
F-44702UK Vaccine Administration Record, Ukrainian DPH Ukrainian 04/2025 PDF No
F-03196 Vaccine Borrowing Report DPH English 04/2024 PDF No
F-02502 Vaccine for Adults (VFA) Community Outreach DPH English 04/2022 PDF No
F-02495 Vaccine for Adults (VFA) Provider Agreement DPH English 09/2024 PDF No
F-02503 Vaccine for Outbreak Response Request DPH English 08/2019 PDF No
F-01744 Vaccine Restitution Policy - Agreement DPH English 02/2025 PDF No
F-02287 Vaccine Return - Request for Authorization to Return DPH English 02/2025 PDF No
F-21059 Variance Request for Institution Respite DMS English 03/2017 Word No
F-21059 Variance Request for Institution Respite DMS English 03/2017 PDF 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 01/2024 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-01017A Verbal Orders for Recertification: Home Health Agency Request for Variance of Physician Signature Requirement Completion Instructions DMS English 07/2008 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-03273 Victim Notification Request DCTS English 08/2024 HTML 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 October 27, 2025