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 | Title | Division | Other Location |
|---|---|---|---|
| F-01618 | Medicare Counseling Client Services Agreement | DPH | None |
| F-05022 | Report of Adoption | DPH | Other |
| F-01313 | Register to Reschedule Lead (Pb) Certification Exam | DPH | None |
| F-01647 | Coverdell Emergency Medical Services (EMS) Partner Agreement | DPH | None |
| F-01648 | Coverdell Stroke Care Partner Agreement | DPH | None |
| F-01649 | Coverdell Stroke Champion Partner Agreement | DPH | None |
| F-00054 | Request for Waiver of Education / Experience Requirements (ADRC) | DPH | None |
| F-02839 | Letter: IRIS Individual Support and Service Plan (ISSP) Signature Request | DMS | None |
| F-02562 | Disability Benefit Specialist Program Client Services Agreement | DPH | None |
| F-01204 | Notice of Action—IRIS Program | DMS | None |
| F-02122 | Opioid Crisis State Targeted Response Program Funding Request | DCTS | None |
| F-44763 | Emergency Care Do Not Resuscitate Order (DNR) | DPH | None |
| F-00634B | Records Access Log, Birth to 3 Program | DMS | None |
| F-02833 | IRIS Performance Improvement Project Annual Report | DMS | None |
| F-02832 | IRIS Performance Improvement Project (PIP) Proposal | DMS | None |
| F-44062 | Lead Training Manager Application | DPH | None |
| F-01293D | Participant Fiscal Employer Agent (FEA) Transfer Checklist | DMS | None |
| F-44063 | Lead (Pb) Principal Instructor Application | DPH | None |
| F-02835 | Opening Avenues to Reentry Success (OARS2) Informed Consent for Mental Health Evaluation, Treatment, and Community Reintegration Services | DCTS | None |
| F-01293B | Fiscal Employer Agent (FEA) Change Denial Letter | DMS | None |
| F-00851 | AIDS/HIV Drug Assistance and Insurance Assistance Programs - Six-Month Verification | DPH | None |
| F-02031 | Initial Lead Application - Individual Certification | DPH | None |
| F-00238 | Prior Authorization Drug Attachment for Hypoglycemics, Glucagon-Like Peptide (GLP-1) Agents | DMS | None |
| F-01204E | Letter – IRIS Program Notice of Action – Functional Eligibility | DMS | None |
| F-21353 | CLTS One Time High-Cost Notification | DMS | None |
| F-21353i | CLTS One Time High-Cost Notification Instructions and Typical Ranges | DMS | None |
| F-00805 | Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents | DMS | None |
| F-00194 | Prior Authorization Drug Attachment for Antiemetics, Cannabinoids | DMS | None |
| F-01204F | IRIS Program Notice of Action Letter – Denied Provider Change | DMS | None |
| F-44003 | Lead-Safe Renovator Application | DPH | None |
| F-11075 | Prior Authorization / Preferred Drug List (PA/PDL) Exemption Request | DMS | None |
| F-01204A | Letter – IRIS Program Notice of Action – Denial | DMS | None |
| F-02666 | Prior Authorization Drug Attachment for Headache Agents, Acute Treatment | DMS | None |
| F-02816 | Annual Review for FoodShare Employment and Training (FSET) Program | DMS | None |
| F-05021 | Report of Legal Name Change | DPH | Other |
| F-00171 | Lead Company Certification Application | DPH | None |
| F-01204B | Letter – IRIS Program Notice of Action – Limit | DMS | None |
| F-02667 | Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment | DMS | None |
| F-02817 | Annual Review for Division of Medicaid Services (DMS) Vendors | DMS | None |
| F-01204C | Letter – IRIS Program Notice of Action – Reduction | DMS | None |
| F-00163 | Prior Authorization / Drug Attachment for Anti-Obesity Drugs | DMS | None |
| F-00081 | Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents – Buprenorphine | DMS | None |
| F-01989 | Renewal Application – Individual Lead Disciplines | DPH | None |
| F-01749 | Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting | DMS | None |
| F-01204D | Letter – IRIS Program Notice of Action – Termination | DMS | None |
| F-02346 | Training Course Accreditation Application Lead Disciplines | DPH | None |
| F-00567 | Emergency Medical Services Complaint | DPH | None |
| F-02829 | Confidentiality Agreement For Receipt of CMS Unique ID – SHIP | DPH | None |
| F-05103 | Facts About Your Child's Birth Certificate | DPH | Other |
| F-02828 | School P-EBT Verification Letter Template | DMS | None |
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Last Revised: March 23, 2021
