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-43005 Applicant Physician Assurance for J-1 Visa Waiver Applications
F-01438 Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for IRIS Fiscal Employer Agents (FEA)
F-01439 Wisconsin Medicaid Program Provider Agreement and Acknowledgement of Terms of Participation for IRIS Consultant Agencies (ICA)
F-02382 HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet
F-02383 HCBS Heightened Scrutiny Reviewer Assessment and Evidentiary Summary
F-00166 Service Delivery Discrimination Complaint
F-25180 Order of Discharge Upon Expiration of Commitment
F-25205 Order to Transport
F-02377 Supported Decision-Making Agreement
F-01578 Wisconsin’s Self-Directed IT System (WISITS) – Request For User Setup
F-01999A 2020 Retired Senior Volunteer Program: State Match Funding Application
F-01999B 2020 Senior Companion Program: State Match Funding Application
F-01999 2020 Foster Grandparent Program: State Match Funding Application
F-16066 FoodShare Wisconsin Income Change Report
F-40054 Confidential Birth Defects Registry Report
F-01389A MHSIP Youth Satisfaction Survey
F-01389B MHSIP Family Satisfaction Survey
F-01391A Mental Health Statistics Improvement Program (MHSIP) Youth Data Workbook
F-01391B Mental Health Statistics Improvement Program (MHSIP) Family Data Workbook
F-40059 The Emergency Food Assistance Program (TEFAP) Eligibility Certification
F-01563 IRIS Consultant Agency (ICA) Provider Change Letter
F-00615 Change Project Report and Instructions
F-80983 Civil Rights Complaint
F-42029 Authorization to Receive Tetanus-Diphtheria-Acellular Pertussis (Tdap) and/or Varicella Vaccine
F-42030 Authorization to Receive Tetanus-Diphtheria-Acellular Pertussis (Tdap) Vaccine
F-02288 WisCaregiver Career Program: Registration Agreement
F-01105 Prenatal Care Coordination Pregnancy Questionnaire
F-02385 Vaccine Accountability -Vaccine Preventable Disease: Tetanus
F-02389 Fall Medicare Training for Wisconsin Professionals
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs
F-20941 Informed Consent for Participation in Wisconsin's Money Follows the Person (MFP) Demonstration
F-04002 School Report to Local Health Department
F-02346 Training Course Accreditation Application Lead Disciplines
F-02371 Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists
F-02388 MIPPA Grant Agency Application
F-02390 Fall Medicare Training Participant Survey
F-01389 ROSI Adult Satisfaction Survey
F-82018C Work Time Absence Record
F-20934A Plan Recommendation
F-00309 Medicaid Provider Report
F-20935 Status Report to Court for Plan Compliance
F-20933 Court Order for Assessment
F-20934 Court Ordered Assessment and Plan Report
F-44158 WIC Application Brochure/Postcard
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-21343E Alzheimer's Family and Caregiver Support Program (AFCSP) General Information

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Last Revised: May 22, 2018