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-00041 Asbestos Project Notification
F-00983 Aggregate Data Request - Wisconsin Cancer Reporting System (WCRS)
F-16050 Agency Position on the State Quality Control (QC) Finding
F-01679 Communicable Disease / Tuberculosis Screening Questionnaire
F-01354 OARS Individual Service Plan (ISP)
F-47484 Pre-Review Questionnaire and Application Checklist
F-01670 Wisconsin AIDS Drug Assistance Program (ADAP) Exception Report
F-62461 Application for Critical Access Hospital Certification of Approval
F-12025 Wisconsin Medicaid and BadgerCare Plus Managed Care Program Mental Health, Severe Developmental Disability in Children up to Age 3, or Methadone Treatment Exemption Request
F-12026 Wisconsin Medicaid and BadgerCare Plus Managed Care Program Continuity of Care Exemption Request
F-12027 Wisconsin Medicaid and BadgerCare Plus Managed Care Program High Risk Pregnancy Exemption Request
F-12028 Wisconsin Medicaid and BadgerCare Plus Managed Care Program AIDS or HIV Positive Exemption Request
F-12024 Wisconsin Medicaid SSI HMO Program HMO Enrollment Choice - Milwaukee Model
F-04021 Age Grade Level Requirements
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement
F-05032 Report of Birth Certificate Changes After Surrogate Birth
F-01646 AIDS/HIV Assistance and Insurance Assistance Program Insurance Enrollment Report (PDF, 193 KB)
F-00051 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Varicella, Meningococcal Conjugate (MCV4) Vaccine(s)
F-01252 FoodShare Employment and Training (FSET) - Initial Appointment
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice
F-01254 FoodShare Employment and Training (FSET) - Employment Plan (EP) Appointment
F-01255 FoodShare Employment and Training (FSET) - Job Club Appointment
F-01256 FoodShare Employment and Training (FSET) - Discuss FSET Participation
F-01257 FoodShare Employment and Training (FSET) - Workshop Appointment
F-80188 Check Distribution / Attachments
F-62069A Personal Care Agency Complaint Report
F-62062 Hospice License Application
F-00714 Business Associate Agreement - County or Tribal Contract
F-01570 Ice Arena Equipment Maintenance Log
F-01572 Ice Arena Log of Pollutant Exceedance
F-01573 Log of Ice Arena Air Quality
F-01571 Air Quality Measurement Device Maintenance and Calibration Log
F-01221 WISEWOMAN Screening Activity
F-01228 WISEWOMAN Healthy Behavior Intervention Change Assessment
F-01222 WISEWOMAN Diagnostic and Hypertension Management Referral
F-01229 WISEWOMAN Provider Assurances and Training Checklist
F-01223 WISEWOMAN Case Management
F-01565 Wisconsin Medicaid Electronic Health Record (EHR) Incentive Program - Group Practice Patient Volume
F-01564 Wisconsin Medicaid Electronic Health Record (EHR) Incentive Program - Required CEHRT Documentation
F-01226 WISEWOMAN Lifestyle Program Follow-Up
F-00568 EMS Board Sub-Committee Appointment Application
F-47255 Emergency Medical Services Funding Assistance Program Municipal Signature and Population Verification Page
F-00119 Personal Care Agency Application for Approval
F-01361 ForwardHealth Provider Express Enrollment Change of Address
F-00577 Report Fraud
F-22540A Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs Worksheet
F-00024 HSRS Core Summary Report
F-83292 Small Business Concern Feedback
F-01421 WISEWOMAN Monthly Reporting for Direct Services
F-01359 Historical Earnings Verification Request


Last Revised: May 22, 2018