Forms produced by the Wisconsin Department of Health Services are available for downloading and printing from this site. If a form is not available electronically, you will be provided instructions for requesting a paper copy. If you are searching for a form number that does not start with the letter "F," just enter the number you have available and you will get a better search result. Example, looking for DDE-2539? Enter "2539" in the Search Forms field below.
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| Assigned Number | Title | Other Location |
|---|---|---|
| F-16035 | Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) | None |
| F-02324 | Wisconsin’s American Sign Language Interpreter, SSP and CART Directory Sign-Up and/or Change Request | None |
| F-20445 | Individual Service Plan - Medicaid Waivers | None |
| F-02412 | BioSense Platform Organization Security and Confidentiality Policy Agreement | None |
| F-00395 | Family Care / Family Care Partnership Prevocational Services Six-Month Progress Report and Service Plan | None |
| F-20445A | Individual Service Plan – Individual Outcomes | None |
| F-02413 | BioSense Platform User Security and Confidentiality Agreement | None |
| F-83271 | DHS Website Feedback | None |
| F-02384 | Syndromic Surveillance Data Use Application | None |
| F-01634 | Workplace Wellness Grant Program Application | None |
| F-62536 | Home Health Agency ACCS Initial Application / Pre-licensure Desk Review Checklist | None |
| F-00780A | Options Counseling Tip Card Supplement | None |
| F-02410 | Voluntary Property Checklist for Child Care Providers | None |
| F-21343 | Alzheimer's Family and Caregiver Support Program (AFCSP) Budget Report | None |
| F-00905 | Tuberculosis Disease - Initial Medication Request | None |
| F-02296 | Medicaid Fraud Control Elder Abuse Unit Referral | None |
| F-44000 | Tuberculosis Disease Initial Request for Medication | None |
| F-01013 | Nurse Aide Training and Competency Test Reimbursement Request | None |
| F-47097 | Application for Registration of X-Ray Devices | None |
| F-43025 | Document of Anatomical Gift Authorization for Organ and Tissue Donation | None |
| F-16030 | FoodShare Wisconsin Under / Overissuance Worksheet and Overpayment Calculator | None |
| F-02282A | Resident Relocation Plan | None |
| F-05260 | Letter of Non-Marriage Application | None |
| F-01933 | Wisconsin EMS EMT Training Record - NCCP EMT Refresher Requirements | None |
| F-01935 | WIsconsin EMS First Responder Training Record - NCCP First Responder Refresher Requirements | None |
| F-00681DDDL | IRIS (Include, Respect, I Self-Direct) Three (3) Consultant Agency Options (Large Print) | None |
| F-00681DD | IRIS (Include, Respect, I Self-Direct) Four (4) Consultant Agency Options | None |
| F-10119 | Temporary Enrollment for Family Planning Only Services | Other |
| F-00681D | IRIS (Include, Respect, I Self-Direct) Two (2) Consultant Agency Options | None |
| F-00681DL | IRIS (Include, Respect, I Self-Direct) Two (2) Consultant Agency Options (Large Print) | None |
| F-00681DDDD | IRIS (Include, Respect, I Self-Direct) Five (5) Consultant Agency Options | None |
| F-00681DDL | IRIS (Include, Respect, I Self-Direct) Four (4) Consultant Agency Options (Large Print) | None |
| F-00681DDDDL | IRIS (Include, Respect, I Self-Direct) Five (5) Consultant Agency Options (Large Print) | None |
| F-00681DDD | IRIS (Include, Respect, I Self-Direct) Three (3) Consultant Agency Options | None |
| F-62096A | DQA Authority for Obtaining Provider Records Without Written Release | None |
| F-43005 | Applicant Physician Assurance for J-1 Visa Waiver Applications | None |
| F-43006 | Health Care Employer Assurance for J-1 Visa Waiver Applications | None |
| F-01468A | IRIS Program Start Date Letter – Transferring Participant | None |
| F-01439 | Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for IRIS Consultant Agencies (ICA) | None |
| F-01438 | Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for IRIS Fiscal Employer Agents (FEA) | None |
| F-02382 | HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet | None |
| F-02383 | HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary | None |
| F-00166 | Service Delivery Discrimination Complaint | None |
| F-25180 | Order of Discharge Upon Expiration of Commitment | None |
| F-25205 | Order to Transport | None |
| F-02377 | Supported Decision-Making Agreement | None |
| F-01578 | Wisconsin’s Self-Directed IT System (WISITS) – Request For User Setup | None |
| F-01999A | 2020 Retired Senior Volunteer Program: State Match Funding Application | None |
| F-01999B | 2020 Senior Companion Program: State Match Funding Application | None |
| F-01999 | 2020 Foster Grandparent Program: State Match Funding Application | None |
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Last Revised: May 22, 2018
