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 Numbersort ascending Title Other Location
F-47463 Emergency Medical Service (EMS) Provider Application and Operational Plan
F-47461D Label-Prewash
F-47461C Label-Sanatize
F-47461B Label-Rinse
F-47461A Label-Wash
F-47300 Ambulance Run Report (page 3) Skills /  Extended Comments (PDF, 55 KB)
F-47257 Program Expenditure Report - Emergency Medical Service Funding Assistance For Ambulance Service Providers
F-47255 Emergency Medical Services Funding Assistance Program Municipal Signature and Population Verification Page
F-47247 Ambulance Attendant License/Permit Renew
F-47242 Asbestos Certification Application
F-47236 Operations and Maintenance Certificate
F-47228 Report of Enforcement Methods
F-47226 Report of Enforcement Methods (Part II)
F-47225 Report of Enforcement Methods (Part 1)
F-47222 Summary Suspension
F-47219 Agent Change Sheet
F-47217 Bed and Breakfast Establishments Inspection Report
F-47205 Swimming Pool Inspection Report
F-47204 Hazard Summary Form
F-47198 Noise Exposure Sampling Sheet
F-47181 First Responder Certification Card
F-47141 Emergency Medical Technician-Paramedic Training Permit Application
F-47128 Emergency Medical Technician - Basic Training Permit Application
F-47125 Emergency Medical Technician - Intermediate Training Permit Application
F-47119 Ambulance Report
F-47097 Application for Registration of X-Ray Devices
F-47029 Monthly Swimming Pool Operation Report
F-47020 Sink Requirements
F-47009 Hotel / Motel or Tourist Rooming House Inspection Report
F-45038 Wisconsin Mercury Exposure Study
F-45032 License, Permit or Registration - Radiation Only
F-45031 Waterslide Inspection Report
F-45030 Inspection Narrative
F-45029i Instructions For School Food Safety Plan
F-45029 School Food Safety Program Inspection Report
F-45025 Patient Questionnaire
F-45023 Certificate - Use of Depleted Uranium under General License
F-45022 Application for Material License
F-45021 Generally Licensed Device Inspection by Mail
F-45020 Cumulative Occupational Exposure History
F-45019 Reciprocity Privileges Checklist
F-45017 Application for Radioactive Material License Authorizing the Use of Sealed Sources
F-45016 Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope
F-45015 Application for Radioactive Material License for Broad Scope
F-45014 Application for Radioactive Material License Authorizing the Use of Self Shielded Irradiators
F-45013 Application for a Radioactive Material License Authorizing the Use of Industrial Radiography
F-45012 Application for a Radioactive Material License for a Commercial Radiopharmacy
F-45011 Certificate - In Vitro Testing with Radioactive Material Under General License
F-45010G Training, Experience and Preceptor Attestation - G (Authorized Medical Physicist)
F-45010F Training, Experience and Preceptor Attestation - F (Authorized Nuclear Pharmacist)

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Last Revised: July 28, 2017