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-00519 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Initial Certification Application - DHS 75.07 DQA
F-13024 Medicaid Purchase Plan Premium - Employer Wage Withholding Information and Instructions DMS
F-00926A Request for Use of Medical Restraints – CLTS DMS
F-11049 Prior Authorization / Drug Attachment (PA/DGA) DMS
F-01486 IRIS Consultant Biography DMS
F-10162 Verification of Veterans Benefits DMS
F-01402 Test Your Knowledge About Trauma-Informed Care DCTS
F-11134 Personal Care Prior Authorization Provider Acknowledgement DMS
F-40117 Abortion Information Provision Certification DPH
F-05260 Letter of Non-Marriage Application DPH
F-82006 Employment Application and Resume DES
F-02035 Aging/ADRC Integration Funding Request Application DPH
F-22688 Collaborative Systems of Care (CSOC) Quarterly Reporting Information Guide DCTS
F-62687 Nurse Aide Training Program - Trainer Application DQA
F-01894 Vendor Overpayment Findings Letter DMS
F-02541 Wisconsin Birth Defects Condition Nomination DPH
F-01310A IRIS Program Conflict of Interest Disclosure - Participant DMS
F-01915 Marketplace or Indicator Gap Filling Eligibility Determinations Supplemental Letter DMS
F-02544 Nursing Home Immediate Jeopardy (IJ) Removal Plan DQA
F-01312 IRIS Provider Application DMS
F-00020 Drug Addition Review Request DMS
F-00158 Assisted Living Administrator Training Course - Application for Training Curriculum DQA
F-20818 Certification for SSI-E Exceptional Expense Supplement DMS
F-01197 Certification of Need for Specialized Medical Vehicle Transportation DMS
F-62447 Misconduct Incident Report DQA
F-01619 OARS Welcome Letter DCTS
F-00615 Change Project Report and Instructions DPH
F-13167 Wisconsin SeniorCare HIPAA Privacy Revocation of Authorization DMS
F-01785 Letter - 40-Hour Health and Safety Assurance Policy Exception Request Denial DMS
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS
F-60953 Adult Family Home Fire Safety Guide DQA
F-01204F IRIS Program Notice of Action Letter – Denied Provider Change DMS
F-00471 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Recertification Application - DHS 75.14 DQA
F-11304 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis DMS
F-00885 Specialized Medical Vehicle Insurance Documentation Checklist DMS
F-45010F Training, Experience and Preceptor Attestation - F (Authorized Nuclear Pharmacist) DPH
F-11031 Prior Authorization / Psychotherapy Attachment (PA/PSYA) DMS
F-01454C IRIS Program Withdrawal Letter – No Contact DMS
F-00315A Written Prior Notice - No Evaluation Recommended DMS
F-02296 Medicaid Fraud Control Elder Abuse Unit Referral OIG
F-44010 Lead-Free / Lead-Safe Property Registry, Training Course, Class and Roster Database Access Application DPH
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application DMS
F-01359 Historical Earnings Verification Request DMS
F-62418 Adult Day Care Initial Certification Application DQA
F-00395 Family Care / Family Care Partnership Prevocational Services Six-Month Progress Report and Service Plan DMS
F-80883 CARS Contract Adjustment - Extensions and Moves DES
F-01991 ACCESS Application Cover Sheet – Milwaukee Enrollment Services (MilES) DMS
F-22541 Incident Report - Medicaid Waiver Programs DMS
F-02601 Wisconsin 1-2 Bed Adult Family Home (AFH) Application DMS
F-01257 FoodShare Employment and Training (FSET) - Workshop Appointment DMS


Last Revised: March 26, 2019