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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-10139S BadgerCare Plus Premium Information / Payment (Spanish) DMS Spanish 03/2018 PDF No
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application DMS English 07/2008 PDF No
F-01726 Basic Equipment List for Nurse Aide Training Programs DQA English 01/2023 Word No
F-01346 Behavior Monitoring Record-Model (PDF, 521 KB) DPH English 09/2016 PDF No
F-03389 Behavioral Health Certification Section DHS 31 – Crisis Urgent Care and Observation Facilities Application DQA English 07/2025 Word No
F-62504 Behavioral Health Certification Section Initial Certification Application DQA English 11/2019 Word No
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS English 12/2013 PDF No
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS English 12/2013 Word No
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances DQA English 03/2013 PDF No
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances DQA English 03/2013 Word No
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records DQA English 04/2011 PDF No
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records DQA English 04/2011 Word No
F-02412 BioSense Platform Organization Security and Confidentiality Policy Agreement DPH English 11/2018 PDF No
F-02413 BioSense Platform User Security and Confidentiality Agreement DPH English 11/2018 PDF No
F-01427 Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting DMS English 02/2017 Word No
F-01427S Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting, Spanish DMS Spanish 02/2017 Word No
F-01428 Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP) DMS English 02/2017 Word No
F-01428S Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP), Spanish DMS Spanish 02/2017 Word No
F-22550 Birth to 3 Program Parent Statement of Income DMS English 06/2017 PDF No
F-22550 Birth to 3 Program Parent Statement of Income DMS English 06/2017 Word No
F-22550S Birth to 3 Program Parent Statement of Income, Spanish DMS Spanish 06/2017 PDF No
F-22550S Birth to 3 Program Parent Statement of Income, Spanish DMS Spanish 06/2017 Word No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information DMS English 11/2019 PDF No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information DMS English 11/2019 Word No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish DMS Spanish 11/2019 Word No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish DMS Spanish 11/2019 PDF No
F-12023 Birth to Three Program HMO Exemption Request DMS English 12/2024 PDF No
F-12023H Birth to Three Program HMO Exemption Request, Hmong DMS Hmong 12/2024 PDF No
F-12023S Birth to Three Program HMO Exemption Request, Spanish DMS Spanish 12/2024 PDF No
F-01758 Blastomycosis Case Worksheet DPH English 08/2016 PDF No
F-01758 Blastomycosis Case Worksheet DPH English 08/2016 Word No
F-00017S Blood Lead Lab Report, Spanish DPH Spanish 02/2025 Word No
F-00017 Blood Lead Lab Reporting DPH English 02/2025 Word No
F-03292 Board for Evaluation of Interpreters (BEI) Certification Transfer Form DPH English 06/2024 Word No
F-40106 Breast Pump Loan and Release Agreement DPH English 08/2022 Word No
F-40106H Breast Pump Loan and Release Agreement, Hmong DPH Hmong 08/2022 Word No
F-40106S Breast Pump Loan and Release Agreement, Spanish DPH Spanish 08/2022 Word No
F-01153 Breast Pump Order DMS English 10/2024 PDF No
F-01153 Breast Pump Order DMS English 10/2024 Word No
F-01601F Budget - Opioid and Stimulant Unmet Needs DCTS English 12/2024 Excel No
F-01210B Budget Amendment Annual Verification (BAAV) Request DMS English 12/2015 Word No
F-00714 Business Associate Agreement - County or Tribal Contract DES English 05/2014 Word No
F-00811 Business Associate Agreement - No Contract DES English 06/2020 PDF No
F-00759 Business Associate Agreement: With Contract DES English 10/2022 PDF No
F-80462 Capital Asset Summary DES English 02/2012 Excel No
F-02331S Caregiver Programs Customer Satisfaction Survey DPH Spanish 05/2018 HTML No
F-02331 Caregiver Programs Customer Satisfaction Survey DPH English 05/2018 HTML No
F-00476 CARES Automated Systems Access Request DMS English 08/2023 PDF No
F-00476A CARES Automated Systems Access Request Instructions DMS English 08/2023 PDF No
F-00052B Cares Data Access and Use Agreement / Designation of Cares Security and Data Exchange Coordinator DPH English 07/2016 Word 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 December 4, 2024