Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Title Division Other Locationsort descending
F-82009W Confidential Information Release Authorization: Two Entities OLC
F-11133 Personal Care Screening Tool (PCST) DMS
F-01769 TEFAP Soup Kitchen Self-Assessment DPH
F-47463C Intermediate Technician Operational Plan Components DPH
F-02616 Supervised Release (SR) Client Vehicle Purchase Request DCTS
F-01622 OARS Records Checklist DCTS
F-02503 Vaccine for Outbreak Response Request DPH
F-00004A Health and Employment Counseling - I Think I Need More Time DMS
F-11018 Prior Authorization Request Form (PA/RF) DMS
F-10109 Medicaid / BadgerCare Plus Remaining Deductible Update DMS
F-01205J IRIS Participant Education: Self-Directed Personal Care DMS
F-40093 Annual ROSIE User Security and Confidentiality Agreement DPH
F-02431 Statement About U.S. Military Service DMS
F-01442E IRIS Program Disenrollment Letter – Ineligible Setting DMS
F-22541 Incident Report – IRIS DMS
F-20934 Court Ordered Assessment and Plan Report DCTS
F-01206A IRIS One-Time Expense Vendor Bid Comparison DMS
F-01219 WISEWOMAN Health History Assessment DPH
F-16039 Waiver of Administrative Disqualification Hearing DMS
F-00385 Nurse Aide Training - Student Waiver Request DQA
F-01068H General Pediatric Clinic - 18 Month Visit DMS
F-62601 Rights of Home Health Agency Patients DQA
F-02759 Comprehensive Community Services Cost Settlement Advance Request DMS
F-13145 HIPAA Privacy Authorization for Use or Disclosure DMS
F-02031 Initial Lead Application - Individual Certification DPH
F-02661 Supervised Release Client Work/Education Request DCTS
F-11067 Record of Actual Daily Oxygen Use DMS
F-00192 Referral / Communication Wisconsin WIC Program DPH
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH
F-45019 Reciprocity Privileges Checklist DPH
F-02593 Rapid Testing Log DPH
F-10180 New Enrollee Health Needs Assessment (NEHNA) Survey - Enrollee Version DMS
F-01670 Wisconsin AIDS Drug Assistance Program (ADAP) Exception Report DPH
F-44063 Lead (Pb) Principal Instructor Application DPH
F-02107C Family Adult Day Care Center – New Provider Certification Application DQA
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS
F-11075 Prior Authorization / Preferred Drug List (PA/PDL) Exemption Request DMS
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH
F-45020 Cumulative Occupational Exposure History DPH
F-02602 1-2 Bed Adult Family Home Certification Application Request DMS
F-01210B Budget Amendment Annual Verification (BAAV) Request DMS
F-02107D Family Adult Day Care Center – New Provider Certification Application Checklist DQA
F-05291 Wisconsin Birth Certificate Application DPH
F-00989K Transition Plan - Other (IFSP) DMS
F-02436A PrEP Questionnaire DPH
F-00101 Authorization to Request Birth Records DMS
F-01313 Register to Reschedule Lead (Pb) Certification Exam DPH
F-01423 AIDS/HIV Drug Assistance and Insurance Assistance Program, Insurance Enrollment Report DPH
F-21276 DCTS Annual Grant/Contract Application DCTS
F-00233 Renewal Summary Letter DMS


Last Revised: March 23, 2021