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-47470 Change of EMS Medical Director
F-45022 Application for Material License
F-47463C Intermediate Technician Operational Plan Components
F-45023 Certificate - Use of Depleted Uranium under General License
F-47489 EMS Patient Care Worksheet
F-00107W Self-Employment Income Report Worksheet
F-47119 Ambulance Report
F-47463D Intermediate Operational Plan Components
F-00219W Self-Employment Income Report: Farm Business Worksheet
F-47125 Emergency Medical Technician - Intermediate Training Permit Application
F-47463E Paramedic Operational Plan Components
F-44756 Wisconsin Tuberculosis Record Card
F-45020 Cumulative Occupational Exposure History
F-47479 Trauma Care Facility Classification Application
F-47128 Emergency Medical Technician - Basic Training Permit Application
F-47463A First Responder Operational Plan Components
F-00103 Wisconsin Blood Lead Registry User Security and Confidentiality Agreement
F-00116 Wisconsin Blood Lead Registry Organization Security and Confidentiality Agreement
F-44771D Property Investigation Closure Report / Case Management of Children with Elevated Blood Lead Levels
F-44017 Asbestos Application - Individual
F-45010D Training, Experience and Preceptor Attestation - D (Authorized User For Manual Brachytherapy Sources)
F-44243 Sexually Transmitted Diseases Laboratory & Morbidity Epidemiologic Case Report
F-44010 Lead-Free / Lead-Safe Property Registry, Training Course, Class and Roster Database Access Application
F-44019A Immunization Assessment
F-45007 Certificate of Disposition of Materials
F-45014 Application for Radioactive Material License Authorizing the Use of Self Shielded Irradiators
F-44018 Request for Repairs
F-45010E Training, Experience and Preceptor Attestation - E (Authorized User of Remote Afterloader, Teletherapy or Gamma Stereotactic Radiosurgery Units)
F-00221A Family Care / Partnership / PACE / IRIS Change Routing and Instructions
F-44257 Wisconsin Immunization Record Card
F-44011 Application for Registration of Lead-Free or Lead-Safe Property
F-44215 Child Care Center Report to the District Attorney
F-45008 Application for Radioactive Material License for Medical Use
F-44126 Antituberculosis Therapy Program Medication Refill Request
F-44702 Vaccine Administration Record
F-45015 Application for Radioactive Material License for Broad Scope
F-45010F Training, Experience and Preceptor Attestation - F (Authorized Nuclear Pharmacist)
F-45009 Application for Radioactive Material License Authorizing the Use of Sealed Sources in Fixed Gauge Devices
F-44151 Acute and Communicable Disease Case Report
F-44614B AIDS/HIV Drug Insurance Premium Subsidy Program and Drug Assistance Program Application/Recertification Part B - Physician Portion
F-45016 Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope
F-44029 Credit Card Payment
F-45010G Training, Experience and Preceptor Attestation - G (Authorized Medical Physicist)
F-44771A Nursing Case Management Report Case Management of Children with Elevated Blood Lead Levels
F-44013 Lead-Based Paint (LBP) Investigation Summary Report
F-45010A Training, Experience and Preceptor Attestation - A (Radiation Safety Officer For Medical Use)
F-45017 Application for Radioactive Material License Authorizing the Use of Sealed Sources
F-44212 School Report to the District Attorney
F-44001A Legal Notice: Required Immunizations for Admission to Wisconsin Child Care Centers
F-44063 Lead (Pb) Principal Instructor Application

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Last Revised: May 22, 2018