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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-02995 Vaccination Community Outreach Grant Quarterly Report DPH English 03/2022 HTML No
F-44702 Vaccine Administration Record DPH English 10/2010 PDF No
F-44702S Vaccine Administration Record, Spanish DPH Spanish 10/2010 PDF No
F-03196 Vaccine Borrowing Report DPH English 04/2024 PDF No
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 12/2023 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 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
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 02/2024 Word No
F-05024 Voluntary Paternity Acknowledgement DPH English 05/2016 Paper Only Yes
F-05024S Voluntary Paternity Acknowledgement, Spanish DPH Spanish 05/2016 Paper Only Yes
F-02410 Voluntary Property Checklist for Child Care Providers DPH English 04/2024 PDF No
F-02410 Voluntary Property Checklist for Child Care Providers DPH English, Hmong, Spanish 04/2024 HTML No
F-02410H Voluntary Property Checklist for Child Care Providers, Hmong DPH Hmong 04/2024 PDF No
F-02410S Voluntary Property Checklist for Child Care Providers, Spanish DPH Spanish 04/2024 PDF No
F-02879 Vulnerable/High Risk Determination - IRIS Program DMS English 09/2021 Word No
F-16039 Waiver of Administrative Disqualification Hearing DMS English 07/2023 PDF No
F-16039AR Waiver of Administrative Disqualification Hearing, Arabic DMS Arabic 07/2023 PDF No
F-16039CM Waiver of Administrative Disqualification Hearing, Chinese (Simplified) DMS Chinese (Simplified) 07/2023 PDF No
F-16039G Waiver of Administrative Disqualification Hearing, German DMS German 05/2018 PDF No
F-16039H Waiver of Administrative Disqualification Hearing, Hmong DMS Hmong 07/2023 PDF No
F-16039KU Waiver of Administrative Disqualification Hearing, Kurdish DMS Kurdish 05/2018 PDF No
F-16039L Waiver of Administrative Disqualification Hearing, Laotian DMS Laotian 05/2018 PDF No
F-16039R Waiver of Administrative Disqualification Hearing, Russian DMS Russian 07/2023 PDF No
F-16039SO Waiver of Administrative Disqualification Hearing, Somali DMS Somali 07/2023 PDF No
F-16039S Waiver of Administrative Disqualification Hearing, Spanish DMS Spanish 07/2023 PDF No
F-62369 Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF) DQA English 04/2009 PDF No
F-62369 Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF) DQA English 04/2009 Word No
F-62369S Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF), Spanish DQA Spanish 04/2009 PDF No
F-62369S Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a Community Based Residential Facility (CBRF), Spanish DQA Spanish 04/2009 Word No
F-60289 Waiver or Variance Request - Community Mental Health and Substance Abuse Treatment Services DQA English 09/2023 Word No
F-03039 WCESIL Membership Agreement DPH English 05/2022 HTML No
F-01302 Weekly Driver's Vehicle Inspection Report DMS English 09/2019 PDF No

Glossary

 
Last revised August 26, 2024