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-01310A IRIS Program Conflict of Interest Disclosure - Participant
F-00162 Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids
F-00040 Asbestos Course Accreditation - Renewal
F-62022A Instructions for Report of Hours Worked and Resident Census Forms
F-01700 Exception-to-Policy Request (AIDS/HIV)
F-47128 Emergency Medical Technician - Basic Training Permit Application
F-11039 Prior Authorization / Spell of Illness Attachment (PA/SOIA)
F-44800 Farmers Market Nutrition Program (FMNP) - Application for Farmers' Market Managers
F-10147 Wisconsin Veterans Home at King - Medicaid Review
F-43024 Wisconsin Organ and Tissue Recovery and Assessment (TISSUE - SPECIFIC)
F-00302 Community Substance Abuse Services (CSAS) Outpatient Clinic Recertification Application - DHS 75.13 Outpatient Treatment Service
F-01312 IRIS Provider Application
F-00163 Prior Authorization / Drug Attachment for Anti-Obesity Drugs
F-00041 Asbestos Project Notification
F-44192 Child Care Immunization Record
F-00989A Child and Family Information (IFSP)
F-01427 Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting
F-40063 TEFAP / CSFP Commodities Complaint
F-01225 WISEWOMAN Health Coaching Follow-Up
F-22637 Interagency Notification -Termination of Community Waiver Participation
F-80477A Canteen Operations Analysis of Cash - GAAP Basis
F-01205G IRIS Participant Education: Notices of Action and Appeals
F-21059 Variance Request for Institutional Respite
F-01104 Specialized Psychiatric Rehabilitation Services (SPRS) Monthly Roster
F-16038 Administrative Disqualification Hearing Notice
F-00944 Request for Approval: Comprehensive Community Services (CCS) Regional Service Model
F-00657 Military Training Verification
F-00565A County Performance Plan (CPP) Outcomes
F-02066 Abbreviated Denial Corrective Action Plan (CAP) Wisconsin WIC Program
F-62644 Drug Repository Program Donation, Transfer, and Destruction Record
F-11307 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail
F-13149 HIPAA Privacy Accounting Request
F-11130 Federally Qualified Health Center Interim Report
F-45021 Generally Licensed Device Inspection by Mail
F-11021 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS2)
F-00367G Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information
F-00114 EMS Service Director License Proxy for Individuals
F-01619 OARS Welcome Letter
F-00004B Health and Employment Counseling - I Have Reached Employment
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist
F-44614A AIDS/HIV Drug Assistance Program and Insurance Assistance Program Application / Recertification
F-00726 Typical Vision Developmental Milestones
F-42017 Wisconsin Initial Refugee Health Assessment
F-29323 Hardship Policy / Hidden Asset Policy
F-01270 Comprehensive Community Services Non-Traditional Approval
F-22468 Application for Services Office for the Blind and Visually Impaired
F-01198 Optional School-Based Services Activity Log Nursing / Therapy Medical Services
F-01066A HealthCheck Child's Food Record / 1 to 12 Years of Age


Last Revised: July 28, 2017