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
F-00551 Emergency Mental Health Service Program Initial Certification Application - DHS 34
F-00401 Expedited Emergency Supply Request
F-02217 Affidavit for Supplemental Nutrition Assistance Program – Puerto Rico
F-02117 Home and Community-Based Settings - Adult Residential Provider Assessment
F-01999 2019 Foster Grandparent Program: State Match Funding Application
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail
F-01899 Central Line-Associated Bloodstream Infection (CLABSI)
F-11044 Prior Authorization / Home Health Therapy / Attachment (PA/HHTA)
F-45010C Training, Experience and Preceptor Attestation - C (Unsealed Radioactive Material Requiring A Written Directive)
F-10151 Medicaid / BadgerCare Plus Fair Hearing Information
F-44013 Lead-Based Paint (LBP) Investigation Summary Report
F-00309 Medicaid Provider Report
F-01319 IRIS Involuntary Disenrollment Request
F-00164 Civil Rights Compliance Plan
F-00042 Knowledge Journal
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA)
F-01567 Long-Term Care Insurance Policy – Assignment of Benefits
F-01546 IRIS Consultant Agency (ICA) Biography
F-40092 Physical Activity Zone
F-44771AA Medicaid Targeted Case Management Face Sheet - Childhood Lead Poisoning
F-25206 Petition for Capias
F-01218 WISEWOMAN Client Consent
F-01206 IRIS One-Time Expense Request
F-21150 Elder Adults/Adults-at-Risk Agency Conflict of Interest Notification and Transfer of Investigation Powers
F-20009 Complaint Report
F-00043 Communication to Local Educational Agency Regarding Child Referral
F-01588 Application for Available Beds
F-01549 IRIS Certification Designation of Confidential and Proprietary Information
F-40093 Annual ROSIE User Security and Confidentiality Agreement
F-01418 21-Day Monitoring Period Chart
F-25207 Order Granting Capias
F-01219 WISEWOMAN Health History Assessment
F-01206A IRIS One-Time Expense Vendor Bid Comparison
F-21150A Adult Protective Services (APS) Investigation Transfer - Model
F-01118 Child Care Coordination Family Questionnaire
F-20224 Office for the Blind and Visually Impaired Assessment / Plan / Evaluation
F-00963 Children’s Long Term Support Reconciliation Packet
F-00676 Youth Transition Pretest
F-00520 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Initial Certification Application - DHS 75.06
F-25393A Petition for Supervised Release
F-02108 Adult Family Home
F-80190 Travel Reimbursement Request Non-State Employee
F-02061 Pharmacy Benefit Manager (PBM) Insurance Disclosure Onboarding
F-62586 Challenge Exam Applicant Nurse Aide / Medication Aide
F-01951 Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis
F-13158 Wisconsin Chronic Disease Program (WCDP) HIPAA Privacy Complaint
F-62157 Living Unit Direct Care Staff Report - Evening Shift
F-11245 Family Planning Clinics or Agencies
F-11027 Rural Health Clinic Quarterly Cost Report
F-00367J Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 12 - 14 Years

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Last Revised: May 22, 2018