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 Titlesort descending Other Location Language
F-42029 Authorization to Receive Tetanus-Diphtheria-Accellular Pertussis (Tdap) and/or Varicella Vaccine English
F-42030 Authorization to Receive Tetanus-Diphtheria-Accellular Pertussis (Tdap) Vaccine English
F-00101 Authorization to Request Birth Records English
F-20987 Authorized Representative Designation, Medicaid Community Waiver Programs English
F-02118 Authorized Signer Designation for Access to PPS and FSIA English
F-21077 Autism Treatment Services Criteria Checklist Instructions English
F-01352 Background Check Appeal Request - IRIS Program English
F-82064 Background Information Disclosure (BID) English
F-82069 Background Information Disclosure (BID) Appendix English
F-01246 Background Information Disclosure Addendum—IRIS English
F-10115 BadgerCare Plus / Medicaid Health Insurance Information English
F-10182 BadgerCare Plus Application Packet English
F-10185 BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication English
F-11309 BadgerCare Plus Express Enrollment for Children Provider Certification (PDF, 93 KB) English
F-11268 BadgerCare Plus Express Enrollment for Pregnant Women Provider Certification (PDF, 83 KB) English
F-10184 BadgerCare Plus Former Foster Care Youth (FFCY) English
F-12085 BadgerCare Plus HMO Program HMO Enrollment Choice English
F-13025 BadgerCare Plus Premium Employer Wage Withholding (PDF, 94 KB) English
F-10139 BadgerCare Plus Premium Information / Payment English
F-13026 BadgerCare Plus Premium Member / Employer Electronic Funds Transfer (PDF, 202 KB) English
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application (PDF, 654 KB) English
F-10081 BadgerCare Plus – Express Enrollment for Pregnant Women Application English
F-01726 Basic Equipment List for Nurse Aide Training Programs English
F-47217 Bed and Breakfast Inspection Report (PDF, 22 KB) English
F-01346 Behavior Monitoring Record-Model English
F-00922 Behavioral Health Integrated Care Health Home Certification Application English
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 English
F-00276 Behavioral Health Services Renewal Certification Application - DHS 94 and 92 English
F-05004 Birth Amendment - Affidavit English
F-05033 Birth Amendment - Baptismal English
F-05291 Birth Certificate Application - Wisconsin (PDF, 1 MB) English
F-05034 Birth Certificate Facts English
F-01427 Birth to 3 Invitation to EI Team Eligibility Determination and IFSP Meeting English
F-01428 Birth to 3 Invitation to IFSP Meeting English
F-22550 Birth to 3 Program Parental Cost Share English
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information English
F-00017 Blood Lead Lab Reporting English
F-44764 Bracelet Inserts English
F-01153 Breast Pump Order (PDF, 49 KB) English
F-01210B Budget Amendment Annual Verification (BAAV) Request English
F-00714 Business Associate Agreement - County or Tribal Contract English
F-00759 Business Associate Agreement - With Contract English
F-01715 Calculating Expenses for a CLTS Foster Home Using Actual Expenses English
F-01716 Calculating Expenses for a CLTS Foster Home Using the Uniform Foster Care Brochure English
F-47206 Campground Inspection Report English
F-80477A Canteen Operations Analysis of Cash - GAAP Basis English
F-80477B Canteen Operations Balance Sheet - GAAP Basis English
F-80477 Canteen Operations Statement of Revenues / Expenses and Fund Equity Changes - GAAP Basis English
F-80963 Capital Asset Changes / Deletion Record English
F-80462 Capital Asset Summary English

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Last Revised: July 28, 2017