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 Numbersort descending Title Division Other Location
F-02788 Certified Narcotic Treatment Service for Opiate Addiction: Medication Unit Application DQA
F-02805 Attestation for Use of Standing Prescription Order (Dr. Ryan Westergaard, Chief Medical Officer and State Epidemiologist), for trained personnel to collect and/or analyze specimens for COVID-19 testing
F-02813 First Responder Training Access Request DCTS
F-02814 First Responder Training Evaluation DCTS
F-02815 Prior Authorization for Hospital Swing Beds DMS
F-02816 Annual Review for FoodShare Employment and Training (FSET) Program DMS
F-02817 Annual Review for Division of Medicaid Services (DMS) Vendors DMS
F-02823 Client Rights Quiz DCTS
F-02825 Wisconsin Department of Health Services Stockpile Policy and Request DPH
F-02828 School P-EBT Verification Letter Template DMS
F-02829 Confidentiality Agreement For Receipt of CMS Unique ID – SHIP DPH
F-02832 IRIS Performance Improvement Project (PIP) Proposal DMS
F-02833 IRIS Performance Improvement Project Annual Report DMS
F-02835 Opening Avenues to Reentry Success (OARS2) Informed Consent for Mental Health Evaluation, Treatment, and Community Reintegration Services DCTS
F-02839 Letter: IRIS Individual Support and Service Plan (ISSP) Signature Request DMS
F-02857 YCSF Request for Exception-Age DCTS
F-02859 DPH Speaker Request DPH
F-02860 Information and Assistance Supervisor Observation and Support Tool DPH
F-02861 Options Counseling Supervisor Observation and Support Tool DPH
F-02863 Disability Benefit Specialist Program Appointed Representative Agreement DPH
F-02866 FoodShare Request for Proof DMS
F-02867 Facility Eligibility For Services Questionnaire CRT
F-02870 Demographic Assessment for Communities, Boards, Workgroups, and Councils DPH
F-02871 emPOWER Data Use Evaluation DPH
F-02872 Trauma Care Facility Site Reviewer Performance Assessment DPH
F-02874 Letter: Screen Visit Scheduled DMS
F-02875 Self-Care Assessment DPH
F-02876 Letter: Screen Visit Not Scheduled DMS
F-02879 Vulnerable/High Risk Determination – IRIS Program DMS
F-02880 ADRC Location and Physical Space Self-Assessment DPH
F-02881 ADRC Dementia-Capable Training Plan DPH
F-02882 ADRC Dementia Care Specialist Work Plan Template DPH
F-02885 Request for Institution of Mental Disease Determination for Children’s Residential Settings DMS
F-02888 Aging & Disability Resource Center Annual Update Checklist DPH
F-02889 Dementia Knowledge Assessment Tool DPH
F-02892 County Crisis or APS Partner Portal Request DMS
F-02896 Supporting the Wisconsin State Dementia Plan: Volunteer Interest Survey DPH
F-02897 DHS 75 Implementation Questions DCTS
F-04002 School Report to Local Health Department DPH
F-04003 Vendor Monitoring Site Visit Report Wisconsin: WIC Program DPH
F-04020 Student Immunization Record - This form is intended for schools DPH
F-04020L Student Immunization Record, Long DPH
F-05004 Birth Amendment - Affidavit DPH
F-05006 Affidavit Personal Knowledge Delayed Birth Registration DPH
F-05010 Application for Delayed Birth Registration DPH
F-05020 Paternity Order Due to Divorce - Judgment DPH
F-05020A Paternity Order Due to Divorce - Custody DPH
F-05021 Report of Legal Name Change DPH
F-05021C Report of Legal Name Change - Confidential DPH
F-05021T Report of Legal Name Change - Tribal DPH

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Last Revised: March 23, 2021