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 Locationsort descending Language
F-05210 Name Change Request Within 1st Year English
F-05027A Report of Citizenship English
F-05027B Report of Naturalization English
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement English
F-05032 Report of Birth Certificate Changes After Surrogate Birth English
F-05033 Birth Amendment - Baptismal English
F-05004 Birth Amendment - Affidavit English
F-05034 Birth Certificate Facts English
F-05035 Report Change Name, Sex Birth Certificate Surgical Procedure English
F-05020 Paternity Order Due to Divorce - Judgement English
F-44118 WIC Vendor Application English
F-43021 Wisconsin Well Woman Program Multiple Sclerosis (MS) Report and Referral (PDF, 177 KB) English
F-62504 Community Substance Abuse Services (CSAS) or Mental Health Clinic Initial Certification Application English
F-62674 Home Health Agency License Application English
F-62461 Application for Critical Access Hospital Certification of Approval English
F-00119 Personal Care Agency Application for Approval English
F-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency English
F-05218 E-mail Notification Request For New Publication Release English
F-22540 Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs English
F-21225 Program Participation System (PPS): B-3 Module English
F-10110 Medicaid/BadgerCare Plus Eligibility Certification English
F-00343 Eligibility Management (Income Maintenance) Policy Notification Sign-Up English
F-83271 DHS Website Feedback English
F-24277 Informed Consent for Psychotropic Medication English
F-44160A WIC Plastic Cover for WIC ID Folder English
F-00917 Provider Enrollment Application Process English
F-01361 ForwardHealth Provider Express Enrollment Change of Address English
F-00577 Report Fraud English
F-47181 First Responder Certification Card English
F-47247 Ambulance Attendant License/Permit Renew English
F-47471 Emergency Medical Technician Verification of Licensure English
F-47255 Emergency Medical Services Funding Assistance Program Municipal Signature and Population Verification Page English
F-47472 Emergency Medical Techician (EMT) License / First Responder Certification Renewal Application English
F-47477 First Responder / Emergency Medical Technician Certificate / License English
F-47478 First Responder / Emergency Medical Technician Application Electronic Addition to a Roster English

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Last Revised: July 28, 2017