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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-01428S Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP), Spanish (Word) DMS Spanish 02/2017 No
F-22550 Birth to 3 Program Parent Statement of Income (Word) DMS English 06/2017 No
F-22550 Birth to 3 Program Parent Statement of Income (PDF) DMS English 06/2017 No
F-22550S Birth to 3 Program Parent Statement of Income, Spanish (Word) DMS Spanish 06/2017 No
F-22550S Birth to 3 Program Parent Statement of Income, Spanish (PDF) DMS Spanish 06/2017 No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information (Word) DMS English 11/2019 No
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information (PDF) DMS English 11/2019 No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish (Word) DMS Spanish 11/2019 No
F-00632S Birth to 3 Program System of Payments and Consent to Access Private Insurance and Medicaid, Spanish (PDF) DMS Spanish 11/2019 No
F-12023 Birth to Three Program HMO Exemption Request (PDF) DMS English 12/2024 No
F-12023H Birth to Three Program HMO Exemption Request, Hmong (PDF) DMS Hmong 12/2024 No
F-12023S Birth to Three Program HMO Exemption Request, Spanish (PDF) DMS Spanish 12/2024 No
F-01758 Blastomycosis Case Worksheet (PDF) DPH English 08/2016 No
F-01758 Blastomycosis Case Worksheet (Word) DPH English 08/2016 No
F-00017S Blood Lead Lab Report, Spanish (Word) DPH Spanish 08/2025 No
F-00017 Blood Lead Lab Reporting (Word) DPH English 08/2025 No
F-03292 Board for Evaluation of Interpreters (BEI) Certification Transfer Form (Word) DPH English 09/2026 No
F-40106 Breast Pump Loan and Release Agreement (Word) DPH English 08/2022 No
F-40106H Breast Pump Loan and Release Agreement, Hmong (Word) DPH Hmong 08/2022 No
F-40106S Breast Pump Loan and Release Agreement, Spanish (Word) DPH Spanish 08/2022 No
F-01153 Breast Pump Order (PDF) DMS English 10/2024 No
F-01153 Breast Pump Order (Word) DMS English 10/2024 No
F-01601H Budget - MAT in a Jail Setting (Excel) DCTS English 08/2026 No
F-01601F Budget - Opioid and Stimulant Unmet Needs (Excel) DCTS English 08/2026 No
F-01210B Budget Amendment Annual Verification (BAAV) (Word) DMS English 08/2026 No
F-00714 Business Associate Agreement - County or Tribal Contract (Word) DES English 10/2025 No
F-00811 Business Associate Agreement - No Contract (PDF) DES English 10/2025 No
F-00759 Business Associate Agreement: With Contract (PDF) DES English 10/2025 No
F-80462 Capital Asset Summary (Excel) DES English 02/2012 No
F-02331S Caregiver Programs Customer Satisfaction Survey (HTML) DPH Spanish 05/2018 No
F-02331 Caregiver Programs Customer Satisfaction Survey (HTML) DPH English 05/2018 No
F-00476 CARES Automated Systems Access Request (PDF) DMS English 12/2025 No
F-00476A CARES Automated Systems Access Request Instructions (PDF) DMS English 12/2025 No
F-00052B Cares Data Access and Use Agreement / Designation of Cares Security and Data Exchange Coordinator (Word) DPH English 09/2026 No
F-22571A Caretaker Supplement (CTS) Instructions for Application (PDF) DMS English 12/2023 No
F-22571AS Caretaker Supplement (CTS) Instructions for Application, Spanish (PDF) DMS Spanish 12/2023 No
F-22571 Caretaker Supplement Application (PDF) DMS English 12/2023 No
F-00023 Case Management Agency Self-Audit Checklist (PDF) DMS English 01/2017 No
F-01708 Case Management Comprehensive Assessment (PDF) DPH English 05/2016 No
F-01709 Case Management Service Plan (PDF) DPH English 07/2026 No
F-02109B CBRF - Established Provider Licensure Application Checklist (Word) DQA English 08/2022 No
F-02109D CBRF - New Provider Licensure Application Checklist (Word) DQA English 08/2022 No
F-45011 Certificate - In Vitro Testing with Radioactive Material Under General License (Word) DPH English 07/2008 No
F-45023 Certificate - Use of Depleted Uranium under General License (PDF) DPH English 02/2004 No
F-45007 Certificate of Disposition of Materials (PDF) DPH English 03/2010 No
F-45007 Certificate of Disposition of Materials (Word) DPH English 03/2010 No
F-40041 Certification and Food Package Pick-Up (PDF) DPH English 09/2025 No
F-11318 Certification Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus (PDF) OIG English 04/2021 No
F-11317 Certification Criteria for Providers Express Enrollment of Pregnant Women in BadgerCare Plus (PDF) OIG English 04/2021 No
F-02992 Certification Fee Exemption Request for Government Employees (PDF) DPH English 03/2022 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.

Glossary

 
Last revised October 27, 2025