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 Division Other Locationsort descending
F-01555 Reference Sheet – IRIS Consultant Agency (ICA) Assignments by Area of Responsibility DMS
F-44444 WIC Vendor Supply Order DPH
F-62546 Corporate Guardianship Program Annual Report DQA
F-00653 Importing Procedure Records in NHSN (SSI DENOMINATOR) DPH
F-44771AA Medicaid Targeted Case Management Fact Sheet - Childhood Lead Poisoning DPH
F-02109 CBRF – Applicant Compliance Statement DQA
F-00482 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Initial Certification Application - Chapter DHS 36 DQA
F-82064 Background Information Disclosure (BID) DQA
F-25207 Order Granting Capias DCTS
F-01989 Renewal Application – Individual Lead Disciplines DPH
F-00366 Wisconsin Adult Long-Term Care Functional Screen DMS
F-01319 IRIS Involuntary Disenrollment Request DMS
F-20942A Total Expenses All Sources by Target Group and Standard Program Cluster Worksheet OPIB
F-62494 Health Care Facility Construction Documentation Checklist DQA
F-02558 Family Care Member County Notification DMS
F-01626 OARS Facility Checklist DCTS
F-00212 Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment DMS
F-01201 IRIS Education — Hired Worker Set-Up DMS
F-00052 Aging and Disability Resource Center (ADRC) Application DPH
F-01620 Opening Avenues to Reentry Success (OARS) Informed Consent for Mental Health Evaluation, Treatment and Community Reintegration Services DCTS
F-02487 Wisconsin Immunization Registry (WIR) Record Release Authorization DPH
F-00219 Self-Employment Income Report: Farm Business DMS
F-01201A IRIS Participant - Hired Worker Relationship Identification DMS
F-00052A Aging and Disability Resource Center (ADRC) Annual Budget DPH
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB) DMS
F-01068B General Pediatric Clinic - 6 to 8 Week Visit DMS
F-62026 Report of Hours Worked - Nurse Aide / Evening DQA
F-11318 Enrollment Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus OIG
F-01205J IRIS Participant Education: Self-Directed Personal Care DMS
F-45015 Application for Radioactive Material License for Broad Scope DPH
F-00907 Wisconsin Home Health Agency OASIS Assessment Deletion Request DQA
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) DMS
F-01352B IRIS Participant-Hired Worker Background Check Appeal Process - Ineligible Letter DMS
F-44017 Asbestos Application - Individual DPH
F-00103 Wisconsin Blood Lead Registry User Security and Confidentiality Agreement DPH
F-00580 Nursing Home Authorization for Access to Automated MDS 3.0 Section Q Referral Management System DMS
F-10144 Wisconsin Life Insurance Inquiry DMS
F-01207A IRIS Fiscal / Employer Agent Quality Management Plan Tracking DMS
F-40075 Pedometer Walking Program DPH
F-01924 Public Comment on Rulemaking Project OLC
F-80952 Contingency Plan - Health and Human Services Agencies DES
F-01942D LTC FS - Change in Condition - Release of Information Authorization DMS
F-02607 Letter: 1-2 Bed Adult Family Home Recertification Application DMS
F-00464 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Recertification Application - DHS 75.06 DQA
F-22564 Authorization for Retroactive Caretaker Supplement (CTS) DMS
F-00315A Written Prior Notice - No Evaluation Recommended DMS
F-01270 Comprehensive Community Services Non-Traditional Approval DMS
F-62652A Personal Care Agency Home Visit Guide DQA
F-20441Ai Adult-At-Risk Abuse, Neglect, and/or Exploitation Valid Values DPH
F-01781 Immunization Program Functional Exercise 2018-2020 (BP1 Supplemental) DPH


Last Revised: March 26, 2019