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Official DHS Forms Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions. When you are searching for a document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

Assigned number Title Division Language Release date Available to order
F-25213 Admission to Caseload - Mental Health (Word) DCTS English 12/2016 No
F-25213 Admission to Caseload - Mental Health (PDF) DCTS English 12/2016 No
F-25904 Admission to Caseload - Revocation (Word) DCTS English 07/2026 No
F-03377 Adolescent Inpatient Mental Health Program DHS 61.79 - Applicant Compliance Statement (Word) DQA English 05/2025 No
N/A ADRC Action Plan (PDF) DPH English 06/2025 No
F-02057 ADRC Authorization for the Release of Confidential Information (Word) DPH English 08/2017 No
F-02057S ADRC Authorization for the Release of Confidential Information, Spanish (Word) DPH Spanish 08/2017 No
F-00052D ADRC Dissolution Planning Checklist (Word) DPH English 01/2023 No
F-02714 ADRC Professional Training Participant Survey (HTML) DPH English 09/2020 No
F-02053 ADRC Referral to Income Maintenance for Managed Long-Term Care Services (Word) DPH English 12/2025 No
F-03093 ADRC Specialist Customer Service Agreement (PDF) DPH English 09/2025 No
F-03093DS ADRC Specialist Customer Service Agreement (DocuSign) (HTML) DPH English 09/2025 No
F-03093H ADRC Specialist Customer Service Agreement, Hmong (PDF) DPH Hmong 09/2025 No
F-03093S ADRC Specialist Customer Service Agreement, Spanish (PDF) DPH Spanish 09/2025 No
F-00054 ADRC/Aging/Tribal Agency Request for Approval of Alternative Staff Experience and/or Training (Word) DPH English 06/2022 No
F-02634 Adult Day Care Center (ADCC) Initial Survey Checklist (Word) DQA English 07/2026 No
F-03145 Adult Day Care Center Self-Report (Word) DQA English 04/2023 No
F-03369B Adult Day Care Center: Home and Community Based Service (HCBS) Review Reviewer Guidelines (Word) DQA English 07/2026 No
F-02634A Adult Family Home (AFH) Initial Survey Checklist (Word) DQA English 07/2026 No
F-02108B Adult Family Home - Established Provider Licensure Application Checklist (Word) DQA English 08/2022 No
F-02108D Adult Family Home - New Provider Licensure Application Checklist (Word) DQA English 08/2022 No
F-03375 Adult Inpatient Mental Health Program DHS 61.71 - Applicant Compliance Statement (Word) DQA English 05/2025 No
F-03250 Adult Long-Term Care (LTC) Waiver Provider Application Information and Instructions (PDF) DMS English 04/2026 No
F-03250 Adult Long-Term Care (LTC) Waiver Provider Application Information and Instructions (Word) DMS English 04/2026 No
F-01315 AFDC-Related Determination Worksheet (PDF) DMS English 07/2014 No
F-00893 Affidavit of No Social Security Number - EMS Professional License (Word) DPH English 05/2026 No
F-40019 Affirmation of Identity, Residency, or Income (Word) DPH English 09/2026 No
F-40019H Affirmation of Identity, Residency, or Income, Hmong (Word) DPH Hmong 09/2026 No
F-40019S Affirmation of Identity, Residency, or Income, Spanish (Word) DPH Spanish 09/2026 No
F-02220 AFH Exceptions (HTML) DMS English 08/2024 No
F-00367J Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 12 - 14 Years (PDF) DMS English 02/2017 No
F-00367C Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 12 to 18 Months (PDF) DMS English 02/2017 No
F-00367K Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 14 - 18 Years (PDF) DMS English 02/2017 No
F-00367D Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 to 24 Months (PDF) DMS English 02/2017 No
F-00367L Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 18 Years and Up (PDF) DMS English 02/2017 No
F-00367E Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 24 to 36 Months (PDF) DMS English 02/2017 No
F-00367F Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 36 Months - 4 Years (PDF) DMS English 02/2017 No
F-00367G Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years (PDF) DMS English 02/2017 No
F-00367B Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 12 Months (PDF) DMS English 02/2017 No
F-00367H Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 6 - 9 Years (PDF) DMS English 12/2012 No
F-00367I Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 9 - 12 Years (PDF) DMS English 02/2017 No
F-00367A Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: Birth - 6 Months (PDF) DMS English 02/2017 No
F-20418 Agency Application for Access to Web-Based Personal Care Screening Tool (PDF) DMS English 03/2017 No
F-20418 Agency Application for Access to Web-Based Personal Care Screening Tool, Word (Word) DMS English 03/2017 No
F-00639 Agency Data Security Staff User Agreement (PDF) DMS English 02/2020 No
F-10172 Agency Response to the State Quality Assurance (QA) Medicaid Finding (PDF) DMS English 07/2008 No
F-00052A Aging and Disability Resource Center (ADRC) Annual Budget (Excel) DPH English 02/2017 No
F-00052I Aging and Disability Resource Center (ADRC) Application: Instructions (PDF) DPH English 03/2022 No
F-02888 Aging and Disability Resource Center Annual Update Checklist (PDF) DPH English 09/2026 No
F-02888 Aging and Disability Resource Center Annual Update Checklist (DocuSign) (HTML) DPH English 09/2026 No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

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Last revised October 27, 2025