Skip to main content

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-22571A Caretaker Supplement (CTS) Instructions for Application DMS English 12/2023 PDF No
F-22571AS Caretaker Supplement (CTS) Instructions for Application, Spanish DMS Spanish 12/2023 PDF No
F-22571 Caretaker Supplement Application DMS English 12/2023 PDF No
F-00023 Case Management Agency Self-Audit Checklist DMS English 01/2017 PDF No
F-01708 Case Management Comprehensive Assessment DPH English 05/2016 PDF No
F-01709 Case Management Service Plan DPH English 03/2016 PDF No
F-02109 CBRF - Applicant Compliance Statement DQA English 04/2021 Word No
F-02109B CBRF - Established Provider Licensure Application Checklist DQA English 08/2022 Word No
F-02109D CBRF - New Provider Licensure Application Checklist DQA English 08/2022 Word No
F-45011 Certificate - In Vitro Testing with Radioactive Material Under General License DPH English 07/2008 Word No
F-45023 Certificate - Use of Depleted Uranium under General License DPH English 02/2004 PDF No
F-45007 Certificate of Disposition of Materials DPH English 03/2010 PDF No
F-45007 Certificate of Disposition of Materials DPH English 03/2010 Word No
F-40041 Certification and Food Package Pick-Up DPH English 12/2022 PDF Yes
F-40041H Certification and Food Package Pick-Up, Hmong DPH Hmong 12/2022 PDF No
F-40041R Certification and Food Package Pick-Up, Russian DPH Russian 12/2022 PDF No
F-40041S Certification and Food Package Pick-Up, Spanish DPH Spanish 12/2022 PDF No
F-11318 Certification Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus OIG English 04/2021 PDF No
F-11317 Certification Criteria for Providers Express Enrollment of Pregnant Women in BadgerCare Plus OIG English 04/2021 PDF No
F-02992 Certification Fee Exemption Request for Government Employees DPH English 03/2022 PDF No
F-20818 Certification for SSI-E Exceptional Expense Supplement DMS English 09/2019 Word No
F-20818 Certification for SSI-E Exceptional Expense Supplement DMS English 09/2019 PDF No
F-20818S Certification for SSI-E Exceptional Expense Supplement, Spanish DMS Spanish 08/2008 PDF No
F-01162 Certification of Emergency for Non-U.S. Citizens DMS English 02/2009 PDF No
F-01162A Certification of Emergency for Non-U.S. Citizens Completion Instructions DMS English 02/2009 PDF No
F-11047 Certification of Need for Elective / Urgent Psychiatric / Substance Abuse Admissions to Hospital Institutions for Mental Disease for Members Under Age 21 DMS English 02/2009 PDF No
F-01197 Certification of Need for Specialized Medical Vehicle Transportation DMS English 06/2009 Word No
F-01197 Certification of Need for Specialized Medical Vehicle Transportation DMS English 06/2009 PDF No
F-01197A Certification of Need for Specialized Medical Vehicle Transportation Completion Instructions DMS English 06/2009 PDF No
F-01788 Certification Regarding Debarment and Suspension DES English 03/2022 Word No
F-02788 Certified Narcotic Treatment Service for Opiate Addiction: Medication Unit Application DQA English 04/2021 Word No
F-02788 Certified Narcotic Treatment Service for Opiate Addiction: Medication Unit Application DQA English 04/2021 PDF No
F-00191 Certified Outpatient Clinic: Request for a Branch Office DQA English 06/2019 PDF No
F-00191 Certified Outpatient Clinic: Request for a Branch Office DQA English 06/2019 Word No
F-00191A Certified Outpatient Clinic: Request for a School Branch Office DQA English 06/2019 Word No
F-00191A Certified Outpatient Clinic: Request for a School Branch Office DQA English 06/2019 PDF No
F-62586 Challenge Exam Applicant Nurse Aide / Medication Aide DQA English 08/2022 PDF No
F-62586 Challenge Exam Applicant Nurse Aide / Medication Aide DQA English 08/2022 Word No
F-47470 Change of EMS Medical Director DPH English 02/2022 PDF No
F-47470 Change of EMS Medical Director DPH English 02/2022 Word No
F-00615 Change Project Report and Instructions DPH English 12/2018 Word No
F-00615A Change Project Summary and Instructions DPH English 05/2018 Word No
F-00989A Child and Family Information (IFSP) DMS English 02/2017 Word No
F-00989AS Child and Family Information (IFSP), Spanish DMS Spanish 02/2017 Word No
F-44215 Child Care Center Report to the District Attorney DPH English 12/2017 PDF No
F-03391 Child Care Coordination (CCC) Care Plan DMS English 07/2025 PDF No
F-03391 Child Care Coordination (CCC) Care Plan DMS English 07/2025 Word No
F-03391A Child Care Coordination (CCC) Care Plan Instructions DMS English 07/2025 PDF No
F-01118 Child Care Coordination (CCC) Family Questionnaire Domains and Questions DMS English 07/2025 PDF No
F-01118 Child Care Coordination (CCC) Family Questionnaire Domains and Questions DMS English 07/2025 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