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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-03176 Wisconsin Electronic Disease Surveillance System (WEDSS) User Security and Confidentiality Agreement DPH English 06/2023 PDF No
F-40309A Wisconsin Emergency Assistance Volunteer Registry (WEAVR) Administrative Access User Security and Confidentiality Agreement DPH English 07/2008 PDF No
F-40309 Wisconsin Emergency Assistance Volunteer Registry (WEAVR) Administrative Access User Security and Confidentiality Policy DPH English 07/2008 PDF No
F-02741 Wisconsin Emergency Assistance Volunteer Registry (WEAVR) Staffing Request DPH English 06/2023 Word No
F-01933 Wisconsin EMS Continuing Education Emergency Medical Technician: Requirements DPH English 03/2023 Word No
F-01934 Wisconsin EMS First Responder Training Record - First Responder Refresher Requirements DPH English 02/2019 PDF No
F-01935 Wisconsin EMS First Responder Training Record - NCCP First Responder Refresher Requirements DPH English 03/2023 PDF No
F-01938 Wisconsin EMS Paramedic Training Record - NCCP Paramedic Refresher Requirements DPH English 03/2023 PDF No
F-01955 Wisconsin EMS Training Record Critical Care Paramedic Refresher Record DPH English 03/2023 PDF No
F-01954 Wisconsin EMS Training Record NCCP AEMT Refresher Requirements DPH English 03/2023 PDF No
F-02268 Wisconsin Family Caregiver Program Data DPH English 06/2018 Excel No
F-02519 Wisconsin Family Caregiver Support Programs Caregiver Needs Assessment DPH English 11/2022 Word No
F-02519S Wisconsin Family Caregiver Support Programs Caregiver Needs Assessment, Spanish DPH Spanish 11/2022 Word No
F-16019 Wisconsin FoodShare Application DMS English 08/2023 PDF No
F-16019AR Wisconsin FoodShare Application, Arabic DMS Arabic 08/2023 PDF No
F-16019BU Wisconsin FoodShare Application, Burmese DMS Burmese 08/2023 PDF No
F-16019CM Wisconsin FoodShare Application, Chinese Mandarin DMS Chinese Mandarin 08/2023 PDF No
F-16019DA Wisconsin FoodShare Application, Dari DMS Dari 08/2023 PDF No
F-16019H Wisconsin FoodShare Application, Hmong DMS Hmong 08/2023 PDF No
F-16019L Wisconsin FoodShare Application, Laotian DMS Laotian 08/2023 PDF No
F-16019PA Wisconsin FoodShare Application, Pashto DMS Pashto 08/2023 PDF No
F-16019R Wisconsin FoodShare Application, Russian DMS Russian 08/2023 PDF No
F-16019SO Wisconsin FoodShare Application, Somali DMS Somali 08/2023 PDF No
F-16019S Wisconsin FoodShare Application, Spanish DMS Spanish 08/2023 PDF No
F-16019V Wisconsin FoodShare Application, Vietnamese DMS Vietnamese 08/2023 PDF No
F-10141 Wisconsin Funeral and Cemetery Aids Program Application DMS English 05/2022 PDF No
F-03079 Wisconsin Healthy Smiles Survey DPH 08/2022 HTML No
F-03085A Wisconsin Healthy Smiles Survey: Active Consent DPH English 08/2022 PDF No
F-03085AH Wisconsin Healthy Smiles Survey: Active Consent, Hmong DPH Hmong 08/2022 PDF No
F-03085ASO Wisconsin Healthy Smiles Survey: Active Consent, Somali DPH Somali 08/2022 PDF No
F-03085AS Wisconsin Healthy Smiles Survey: Active Consent, Spanish DPH Spanish 08/2022 PDF No
F-03085B Wisconsin Healthy Smiles Survey: Individual Opt-Out DPH English 08/2022 PDF No
F-03085BH Wisconsin Healthy Smiles Survey: Individual Opt-Out, Hmong DPH Hmong 08/2022 PDF No
F-03085BSO Wisconsin Healthy Smiles Survey: Individual Opt-Out, Somali DPH Somali 08/2022 PDF No
F-03085BS Wisconsin Healthy Smiles Survey: Individual Opt-Out, Spanish DPH Spanish 08/2022 PDF No
F-03085 Wisconsin Healthy Smiles Survey: Site Agreement DPH English 08/2022 PDF No
F-01184 Wisconsin Hemophilia Home Care Program Application DMS English 08/2020 PDF No
F-01184A Wisconsin Hemophilia Home Care Program Application, Instructions DMS English 08/2020 PDF No
F-01187 Wisconsin Hemophilia Home Care Program Financial Need Statement DMS English 02/2018 PDF No
F-01195 Wisconsin Hemophilia Home Care Program Financial Need Statement Cover Memo DMS English 04/2023 PDF No
F-01145 Wisconsin Hemophilia Home Care Program Residency Verification DMS English 02/2018 PDF No
F-44338 Wisconsin HIV Infection and AIDS Case Report DPH English 12/2019 PDF No
F-44338 Wisconsin HIV Infection and AIDS Case Report DPH English 12/2019 Word No
F-44257 Wisconsin Immunization Record Card DPH English 11/2022 PDF Yes
F-02487 Wisconsin Immunization Registry (WIR) Record Release Authorization DPH English 05/2019 PDF No
F-02487CM Wisconsin Immunization Registry (WIR) Record Release Authorization, Chinese DPH Chinese Mandarin 05/2019 PDF No
F-02487HI Wisconsin Immunization Registry (WIR) Record Release Authorization, Hindi DPH Hindi 05/2019 PDF No
F-02487H Wisconsin Immunization Registry (WIR) Record Release Authorization, Hmong DPH Hmong 05/2019 PDF No
F-02487SO Wisconsin Immunization Registry (WIR) Record Release Authorization, Somali DPH Somali 05/2019 PDF No
F-02487S Wisconsin Immunization Registry (WIR) Record Release Authorization, Spanish DPH Spanish 05/2019 PDF No
Last revised July 18, 2023