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 ascending Division Other Location
F-21088 Substance Abuse Prevention Services Information System (SAP-SIS) Agency / User Web Access Request DCTS
F-00659 Substance Abuse Block Grant Prevention Program / Practice Approval DCTS
F-02643 Student Nurse Aide Skills Checklist DQA
F-62696 Student Nurse / Graduate Nurse Verification DQA
F-04020L Student Immunization Record, Long DPH
F-04020 Student Immunization Record - This form is intended for schools DPH
F-16021 Student Financial Aid Report DMS
F-16031 Student Aid and Expense Worksheet DMS
F-16023 Striker Evaluation DMS
F-01344 Strategies for Success with People Who Have Dementia-Behavior Analysis Worksheet-Model DPH
F-20935 Status Report to Court for Plan Compliance DCTS
F-00685 Statement of Tribal Affiliation DMS
F-25177 Statement of Probable Cause and Detention and Petition for Revocation DCTS
F-10175 Statement of Identity for Persons in Institutional Care Facilities DMS
F-10154 Statement of Identity for Children Under 18 Years of Age DMS
F-10161 Statement of Citizenship and/or Identity DMS
F-02431 Statement About U.S. Military Service DMS
F-02430 Statement About Immigration Status DMS
F-00100 State Vital Records Birth Certificate Request Letter DMS
F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request DMS
F-11055 STAT-PA System Instructions DMS
F-20812 SSI-E Natural Residential Setting Application Checklist DMS
F-01104 Specialized Psychiatric Rehabilitation Services (SPRS) Monthly Roster DMS
F-01050 Specialized Medical Vehicle Transportation Trip Ticket / Medical Care Verification DMS
F-11237 Specialized Medical Vehicle Providers Affidavit DMS
F-00885 Specialized Medical Vehicle Insurance Documentation Checklist DMS
F-11296 Specialized Medical Vehicle (SMV) Transportation Service Informational OIG
F-01168 Special Payment Rate Request for Ventilator-Dependent or Brain Injury Cases DMS
F-01345 Special Care Environment Working Document DPH
F-16022 Social Security Number Referral DMS
F-01621 Smoking Cessation Data Collection DCTS
F-62370 Significant Change in Health Screening Instrument Model Form DQA
F-44243 Sexually Transmitted Diseases Laboratory & Morbidity Epidemiologic Case Report DPH
F-01264 Service Fund Application for Reimbursement DPH
F-00166 Service Delivery Discrimination Complaint DES
F-10080 SeniorCare Authorization of Representative DMS
F-10076 SeniorCare Application DMS
F-01999B Senior Companion Program: State Match Funding Application DPH
F-60309 Self-Supervision Evaluation and Waiver Request DQA
F-16035 Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) DMS
F-01985 Self-Employment Income Worksheet: Personal Capital Gains or Losses (Schedule D) DMS
F-16036 Self-Employment Income Worksheet: Partnership (Schedule K-1 [Form 1065] and Form 1065) DMS
F-00219 Self-Employment Income Report: Farm Business DMS
F-00107 Self-Employment Income Report DMS
F-44212 School Report to the District Attorney DPH
F-04002 School Report to Local Health Department DPH
F-02828 School P-EBT Verification Letter Template DMS
F-45029 School Food Safety Program Inspection Report DPH
F-11022 Rural Health Clinic Statistical Data DMS
F-11027 Rural Health Clinic Quarterly Cost Report DMS

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Last Revised: March 23, 2021