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-01766 The Emergency Food Assistance Program (TEFAP) - Shelter Review DPH
F-40059 The Emergency Food Assistance Program (TEFAP) Eligibility Certification DPH
F-40065 The Emergency Food Assistance Program (TEFAP) Storage Facility Review Monitoring Report DPH
F-01768 The Emergency Food Assistance Program - Soup Kitchen Review DPH
F-40060 The Emergency Food Assistance Program Commodities Inventory Report DPH
F-00412 Third Party Administration (TPA) Children's Medicaid Waivers Provider Billing and Service Information DMS
F-00336 Tickborne Rickettsial Disease Case Report DPH
F-02639 Time and Task Pretest DPH
F-20942A Total Expenses All Sources by Target Group and Standard Program Cluster Worksheet OPIB
F-13393 Trading Partner 835 Designation DMS
F-02346 Training Course Accreditation Application Lead Disciplines DPH
F-45010D Training, Experience and Preceptor Attestation - D (Authorized User For Manual Brachytherapy Sources) DPH
F-45010A Training, Experience and Preceptor Attestation - A (Radiation Safety Officer For Medical Use) DPH
F-45010B Training, Experience and Preceptor Attestation - B (Authorized User - Written Directive Not Required) DPH
F-45010C Training, Experience and Preceptor Attestation - C (Unsealed Radioactive Material Requiring A Written Directive) DPH
F-45010E Training, Experience and Preceptor Attestation - E (Authorized User of Remote Afterloader, Teletherapy or Gamma Stereotactic Radiosurgery Units) DPH
F-45010F Training, Experience and Preceptor Attestation - F (Authorized Nuclear Pharmacist) DPH
F-45010G Training, Experience and Preceptor Attestation - G (Authorized Medical Physicist) DPH
F-40064 Transfer of the Emergency Food Assistance Program (TEFAP) Commodities between EFOs DPH
F-00989K Transition Plan - Other (IFSP) DMS
F-00989J Transition Plan - Turning 3 Years Old (IFSP) DMS
F-00315B Transition Written Prior Notice DMS
F-47479 Trauma Care Facility Classification Application DPH
F-80190 Travel Reimbursement Request Non-State Employee DES
F-02547 Treatment Needs Question DMS
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH
F-11129A Tribal and Out-of-State Federally Qualified Health Center Cost Report Completion Instructions DMS
F-11129B-H Tribal and Out-of-State Federally Qualified Health Center Cost Report Forms OIG
F-11130 Tribal and Out-of-State Federally Qualified Health Center Interim Report DMS
F-02462 Tuberculosis (TB) Treatment Assistance Enrollment and Agreement DPH
F-02463 Tuberculosis (TB) Treatment Assistance Program - Request for Reimbursement DPH
F-02461 Tuberculosis (TB) Treatment Assistance Program - Special Request DPH
F-44000 Tuberculosis Disease Initial Request for Medication DPH
F-00905 Tuberculosis Infection (LTBI) Initial Request for Medication DPH
F-02163 Tuberculosis Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement DPH
F-42001 Tuberculosis Suspect Case Data DPH
F-00634A Types and Locations of Early Intervention Records Birth to 3 Program DMS
F-00727 Typical Hearing Developmental Milestones DMS
F-00726 Typical Vision Developmental Milestones DMS
F-10189 Undue Hardship Bed Hold Notice DMS
F-10188 Undue Hardship Waiver Decision for Facility DMS
F-10193 Undue Hardship Waiver Request DMS
F-02140 Urgent Services Agreement DPH
F-00044 User Agreement for System Access DES
F-44702 Vaccine Administration Record DPH
F-02502 Vaccine for Adults (VFA) Community Outreach DPH
F-02495 Vaccine for Adults (VFA) Provider Agreement DPH
F-02503 Vaccine for Outbreak Response Request DPH
F-42000 Vaccine Order DPH

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Last Revised: March 23, 2021