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 Titlesort descending Division Other Location
F-45016 Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope DPH
F-01588 Application for Available Beds DMS
F-02725 Application for COVID Connect Collection Site OS
F-62461 Application for Critical Access Hospital Certification of Approval DQA
F-05010 Application for Delayed Birth Registration DPH
F-01697 Application for Farmers Market or Direct Marketing Farmer EBT FoodShare Payment Processing Equipment DMS
F-45022 Application for Material License DPH
F-45017 Application for Radioactive Material License Authorizing the Use of Sealed Sources DPH
F-45009 Application for Radioactive Material License Authorizing the Use of Sealed Sources in Fixed Gauge Devices DPH
F-45006 Application for Radioactive Material License Authorizing the Use of Sealed Sources in Portable Gauges or XRF Devices DPH
F-45014 Application for Radioactive Material License Authorizing the Use of Self Shielded Irradiators DPH
F-45015 Application for Radioactive Material License for Broad Scope DPH
F-45008 Application for Radioactive Material License for Medical Use DPH
F-01827 Application for Reduction of Cost Share DMS
F-44011 Application for Registration of Lead-Free or Lead-Safe Property DPH
F-47097 Application for Registration of X-Ray Devices DPH
F-22468 Application for Services Office for the Blind and Visually Impaired DPH
F-02306 Application for Telecommunication Assistance Program (TAP) DPH
F-02743 Application Telecommunications Assistance Program Hearing Aid Assistance (TAP HAA) DPH
F-01268 Application to Conduct Intoxicated Driver Assessments, Tribal Treatment Facility DCTS
F-10126 Appoint, Change, or Remove an Authorized Representative DMS
F-22599 Appointment of Authorized Representative for Supplemental Security Income (SSI) DMS
F-01804 Appointment Results Wisconsin WIC Program DPH
F-02052 Asbestos Abatement Project Log DPH
F-44017 Asbestos Application - Individual DPH
F-44002 Asbestos Certification Application - Company DPH
F-00039 Asbestos Course Accreditation - Initial DPH
F-00040 Asbestos Course Accreditation - Renewal DPH
F-44016 Asbestos Occupant Protection Plan DPH
F-00049 Asbestos Principal Instructor Application DPH
F-00041 Asbestos Project Notification DPH
F-20817 Assessment Worksheet for Natural Residential Setting DMS
F-20817A Assessment Worksheet for Natural Residential Setting - for Individuals with Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses DMS
F-02208 Assisted Living Facility Self-Report DQA
F-62548 Assisted Living Facility Waiver, Approval, Variance, or Exception Request DQA
F-02111 Assisted Living – Fit and Qualified Application for Community-Based Residential Facilities and Adult Family DQA
F-01406 Asthma Care (Release of Information ) DPH
F-01408 Asthma Control Summary DPH
F-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency 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 CRT
F-80479 Audit Confirmation Request DES
F-40057 Authorization and Permission For Release of Information to Wisconsin Birth Defects Prevention and Surveillance System and Early Childhood Program DPH
F-00340 Authorization and Release - Photograph, Video, and/or Audio Recording OS
F-00086 Authorization for Final Disposition DPH
F-22565 Authorization for Recoupment Caretaker Supplement DMS
F-42016 Authorization for Release of Confidential HIV Test Results DPH
F-22564 Authorization for Retroactive Caretaker Supplement (CTS) DMS
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail DQA
F-02716 Authorization to Allocate Elder Benefit Specialist Funding to the Aging and Disability Resource Center DPH
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB) DMS


Last Revised: March 23, 2021