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-20691 Request for Exemption - Intoxicated Driver Program (IDP), Employment of Individuals with Lesser Qualifications DCTS
F-25527 Request for Increased Contract Allocation DCTS
F-02885 Request for Institution of Mental Disease Determination for Children’s Residential Settings DMS
F-02746 Request for Institution of Mental Disease Determination for Residential Substance Use Disorder Facilities DMS
F-20448 Request for Medicaid Administrative Funds – Staff Position DMS
F-62457 Request for Permission to Start Construction for Footings and Foundations DQA
F-00330 Request for Replacement FoodShare Benefits DMS
F-20572 Request for State Public Funding for Non-Residents DCTS
F-62608 Request for Use of Medical Restraints DMS
F-00926A Request for Use of Medical Restraints – CLTS DMS
F-62607 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan DMS
F-00926 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan - CLTS DMS
F-00569 Request for Waiver of Administrative Rule for Licensure DPH
F-00054 Request for Waiver of Education / Experience Requirements (ADRC) DPH
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS
F-00054A Request for Waiver of Requirements Relating to Co-Location of an ADRC and ICA/MCO or ADRC and Staff Subcontracted to an ICA/MCO DPH
F-00054B Request for Waiver of Requirements Relating to Organizational Separation when MCO Care Management is Subcontracted to the Same Agency Responsible for ADRC DPH
F-22539 Request for Waiver of State SSI or Caretaker Supplement Overpayment Recovery or Change in Repayment Rate DMS
F-00054D Request for Waiver of the 0.5 Full-Time Equivalent Requirement for ADRC Staff DPH
F-02068 Request to Establish a Children's COP Risk Reserve DMS
F-19002 Request to Reduce QUEST Card Balance DMS
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement DPH
F02637 Requesting FSIA Access During COVID-19 Health Emergency DMS
F-02638 Requesting PPS Access During COVID-19 Health Emergency DMS
F-01885 Requesting State Trauma Registry Access DPH
F-00923 Reschedule Lead (PB) Certification Exam DPH
F-69260 Resident Census and Conditions of Residents CMS-672 DQA
F-62373 Resident Evacuation Assessment DQA
F-02282A Resident Relocation Plan DMS
F-02282 Resident Relocation Roster DMS
F-02634C Residential Care Apartment Complex (RCAC) Initial Survey Checklist DQA
F-02766 Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members DMS
F-40108 Retail Vendor Application Amendment Wisconsin Women, Infant, and Children (WIC) Program DPH
F-01999A Retired Senior Volunteer Program: State Match Funding Application DPH
F-21189 Rights of Detention DCTS
F-62601 Rights of Home Health Agency Patients DQA
F-01558 Risk Agreement – IRIS Program DMS
F-11023 Rural Health Clinic (RHC) Reclassification and Adjustment of Trial Balance Expenses DMS
F-11025 Rural Health Clinic Commercial Insurance-Primary / Medicaid-Secondary Encounters Submitted to Medicaid HMOs DMS
F-11026 Rural Health Clinic Medicaid-Primary Encounters Submitted to Medicaid HMOs DMS
F-11081 Rural Health Clinic Provider Staff Encounters DMS
F-11027 Rural Health Clinic Quarterly Cost Report DMS
F-11022 Rural Health Clinic Statistical Data DMS
F-45029 School Food Safety Program Inspection Report DPH
F-02828 School P-EBT Verification Letter Template DMS
F-04002 School Report to Local Health Department DPH
F-44212 School Report to the District Attorney DPH
F-02875 Self-Care Assessment DPH
F-00107 Self-Employment Income Report DMS
F-00219 Self-Employment Income Report: Farm Business DMS

Pages

Last Revised: March 23, 2021