Forms Library

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.

The Division of Health Care Access and Accountability (DHCAA) and Division of Long Term Care (DLTC) have combined into the Division of Medicaid Services (DMS). When searching for forms by Division, please use the new acronym.

Assigned Number Title Other Location
F-02389 Fall Medicare Training for Wisconsin Professionals
F-40059 The Emergency Food Assistance Program (TEFAP) Eligibility Certification
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs
F-02371 Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists
F-20941 Informed Consent for Participation in Wisconsin's Money Follows the Person (MFP) Demonstration
F-02346 Training Course Accreditation Application Lead Disciplines
F-04002 School Report to Local Health Department
F-02390 Fall Medicare Training Participant Survey
F-80983 Civil Rights Complaint
F-02388 MIPPA Grant Agency Application
F-01389 ROSI Adult Satisfaction Survey
F-01389A MHSIP Youth Satisfaction Survey
F-01389B MHSIP Family Satisfaction Survey
F-82018C Work Time Absence Record
F-00309 Medicaid Provider Report
F-20933 Court Order for Assessment
F-20934 Court Ordered Assessment and Plan Report
F-20934A Plan Recommendation
F-20935 Status Report to Court for Plan Compliance
F-44158 WIC Application Brochure/Postcard
F-16019B FoodShare Wisconsin Registration Packet
F-00166 Service Delivery Discrimination Complaint
F-00588a PPS AODA Deskcard
F-02314 Wisconsin Tuberculosis (TB) Risk Assessment Questionnaire Screen
F-20891 Intoxicated Driver Program Supplemental Funding Request
F-10101 Wisconsin Medicaid for the Elderly, Blind or Disabled Application Packet
F-44001 Legal Notice: Required Immunizations for Admission to Wisconsin Schools
F-02390 Fall Medicare Training Participant Survey
F-21343A Alzheimer's Family and Caregiver Support Program (AFCSP) Financial Eligibility Screen - Worksheets 1 and 2
F-21343E Alzheimer's Family and Caregiver Support Program (AFCSP) General Information
F-00659 Substance Abuse Block Grant Prevention Program / Practice Approval
F-02069 DHS Quarterly Report on Consumers Enrolled in CCS
F-00681EEE IRIS (Include, Respect, I Self-Direct) Fiscal Employer Agent (FEA) Options
F-13033 Probate Claims Notice
F-02282 Resident Relocation Roster
F-01205F IRIS Participant Education: Complaints and Grievances
F-00236 Request for a State Fair Hearing - MCO
F-02230 County Agency Children's Community Option Program (CCOP) Annual Plan Update
F-43025 Document of Anatomical Gift Authorization for Organ and Tissue Donation
F-02367 Non-Addictive, Non-Narcotic, Injectable Medication (NNAI) Medication Assisted Treatment (MAT) Service within the Jail Setting NNAI MAT Re-Entry Grant Application
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist
F-01619 OARS Welcome Letter
F-02385 Vaccine Accountability -Vaccine Preventable Disease: Tetanus
F-44125 Latent Tuberculosis Infection (LTBI) Follow-Up Report
F-00237 Appeal Request - MCOs
F-44764 DNR Bracelet Inserts (22 inserts/sheet)
F-01286 Template for Transition - Final Plan
F-00115 Wisconsin Uniform Placement Criteria (WI-UPC) Adult Placement Scoring Instrument
F-00520 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Initial Certification Application - DHS 75.06
F-05020 Paternity Order Due to Divorce - Judgment


Last Revised: May 22, 2018