Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Title Division Other Locationsort descending
F-02491 FoodShare Buy and Make Food Separately DMS
F-43009 Diabetes Emergency Action Plan DPH
F-01812D Current Occupancy Test Worksheet for Billing Medicaid Bed-Hold Days DMS
F-02324 Wisconsin’s American Sign Language Interpreter, SSP and CART Directory Sign-Up and/or Change Request DPH
F-00367G Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years DMS
F-00221 Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions DPH
F-25180 Order of Discharge Upon Expiration of Commitment DCTS
F-00989-Packet Individualized Family Service Plan (IFSP) Packet DMS
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice DMS
F-02296 Medicaid Fraud Control Elder Abuse Unit Referral OIG
F-20691 Request for Exemption - Intoxicated Driver Program (IDP), Employment of Individuals with Lesser Qualifications DCTS
F-62657 Home Health Agency Contract Review Worksheet DQA
F-01997 Children's Community Options (CCOP) Reconciliation Packet DMS
F-01149 Request for Waiver of Physical Therapist Assistant and Occupational Therapy Assistant Supervision Requirements DMS
F-13160 Wisconsin Chronic Disease Program (WCDP) HIPAA Privacy Revocation of Authorization DMS
F-62319 Hospice Volunteer Program Review DQA
F-01454H IRIS Program Withdrawal Letter – Conflict of Withdrawal DMS
F-00987B EMS Service Operational Plan Advanced Skills Addendum (Advanced) DPH
F-00041 Asbestos Project Notification DPH
F-01766 The Emergency Food Assistance Program (TEFAP) - Shelter Review DPH
F-11130 Tribal and Out-of-State Federally Qualified Health Center Interim Report DMS
F-47463B EMT - Basic Operational Plan Components DPH
F-02614 Fraud Prevention and Investigation Program (FPIP) Fraud Year Contact Information OIG
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants DMS
F-02527 Waiver or Variance Request: Hospital (DHS 124), Home Health Agency (DHS133), and Hospice (DHS 131) DQA
F-00646 Emergency Medical Service Training Center Training Permit Eligibility Certification DPH
F-11016 Prior Authorization Physician Attachment (PA/PA) DMS
F-00476 CARES Automated Systems Access Request DMS
F-44621 WIC Stock Price Survey DPH
F-01204F IRIS Program Notice of Action Letter – Denied Provider Change DMS
F-10109 Medicaid / BadgerCare Plus Remaining Deductible Update DMS
F-00321 OBVI Initial Interview Assessment DPH
F-40085 WIC Program Notice of Ineligibility DPH
F-01442C IRIS Program Disenrollment Letter – No Contact DMS
F-04003 Vendor Monitoring Worksheet: Wisconsin WIC Program DPH
F-02377 Supported Decision-Making Agreement DPH
F-00163 Prior Authorization / Drug Attachment for Anti-Obesity Drugs DMS
F-22540A Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs Worksheet OS
F-01218 WISEWOMAN Client Consent DPH
F-02842 NREMT Candidate Psychomotor Examination Orientation DPH
F-01206 IRIS One-Time Expense Request DMS
F-11018 Prior Authorization Request Form (PA/RF) DMS
F-00479 Child Outcomes Fidelity Self-Assessment DMS
F-01563 IRIS Consultant Agency (ICA) Provider Change Letter DMS
F-02467 Children's Long-Term Support: Care Level Classification DMS
F-00330 Request for Replacement FoodShare Benefits DMS
F-40093 Annual ROSIE User Security and Confidentiality Agreement DPH
F-01442E IRIS Program Disenrollment Letter – Ineligible Setting DMS
F-02367 Non-Addictive, Non-Narcotic, Injectable Medication (NNAI) Medication Assisted Treatment (MAT) Service within the Jail Setting NNAI MAT Re-Entry Grant Application DCTS
F-00164 Civil Rights Compliance Plan OLC

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Last Revised: March 23, 2021