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-04020L Student Immunization Record, Long DPH
F-10182 BadgerCare Plus Application Packet DMS
F-44089 Wisconsin WIC Checks Accepted Here - Stickers DPH
F-40041 Certification and Food Package Pick-Up DPH
F-10075 Wisconsin Well Woman Medicaid Application and Renewal DMS
F-40044 Participant Agreement, Rights & Responsibilities DPH
F-10183 Information Change Report DMS
F-10076 SeniorCare Application DMS
F-10112 Medicaid Disability Application DMS
F-16104 Local Agency Customer Feedback DMS
F-01320 Lead Test Kit Documentation DPH
F-05021 Report of Legal Name Change DPH
F-45029 School Food Safety Program Inspection Report DPH
F-44151 Acute and Communicable Disease Case Report DPH
F-10081 BadgerCare Plus – Express Enrollment for Pregnant Women Application DMS
F-10119 Temporary Enrollment for Family Planning Only Services DMS
F-45029i Instructions For School Food Safety Plan DPH
F-44161 WIC Rights and Responsibilities DPH
F-01336 Wisconsin Assessment of the Impaired Driver (WAID) and Other Substance Users DCTS
F-82009II WIC Confidential Information Release Authorization DPH
F-00888 ADRC Action Plan DPH
F-69259 Long Term Care Facility Application For Medicare and Medicaid CMS-671 DQA
F-01112 HealthCheck Verification Card DMS
F-44243 Sexually Transmitted Diseases Laboratory & Morbidity Epidemiologic Case Report DPH
F-69260 Resident Census and Conditions of Residents CMS-672 DQA
F-44257 Wisconsin Immunization Record Card DPH
F-00740 Client/Patient/Resident Reportable Death: Quality Improvement Event Analysis Summary DQA
F-62062 Hospice License Application DQA
F-12024 Wisconsin Medicaid HMO Enrollment Choice DMS
F-12026 Wisconsin Medicaid and BadgerCare Plus Managed Care Program Continuity of Care Exemption Request DMS
F-12027 Wisconsin Medicaid and BadgerCare Plus Managed Care Program High Risk Pregnancy Exemption Request DMS
F-12028 Wisconsin Medicaid and BadgerCare Plus Managed Care Program AIDS or HIV Positive Exemption Request DMS
F-12029 Managed Care Disenrollment Request DMS
F-44755 WIC Farmers' Market Nutrition Program DPH
F-44757 WIC Farmer's Market Contract For Farmers DPH
F-40058 Verification of Transfer of USDA Commodities DPH
F-40060 The Emergency Food Assistance Program Commodities Inventory Report DPH
F-44824 Wisconsin Day Care Assessment DPH
F-45032 License, Permit or Registration - Radiation Only DPH
F-42000 Vaccine Order DPH
F-05098 Report of Court Order to Correct Facts Misrepresented by Informant for a Wisconsin Birth Record DPH
F-05023 Acknowledgement of Marital Child DPH
F-05102 Wisconsin Immunization Registry Opt-out Request DPH
F-05024 Voluntary Paternity Acknowledgement DPH
F-05027A Report of Citizenship DPH
F-05210 Name Change Request Within 1st Year DPH
F-05027B Report of Naturalization DPH
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement DPH
F-05032 Report of Order for Birth Record Changes Following Surrogate Birth DPH
F-05033 Birth Amendment - Baptismal DPH


Last Revised: March 23, 2021