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 ascending
F-47181 First Responder Certification Card
F-47471 Emergency Medical Technician Verification of Licensure
F-47472 Emergency Medical Techician (EMT) License / First Responder Certification Renewal Application
F-47477 First Responder / Emergency Medical Technician Certificate / License
F-47478 First Responder / Emergency Medical Technician Application Electronic Addition to a Roster
F-47247 Ambulance Attendant License/Permit Renew
F-47255 Emergency Medical Services Funding Assistance Program Municipal Signature and Population Verification Page
F-02341 County Waiver Agency Contact: Wisconsin Children's Long-Term Support (CLTS) Waiver Provider SharePoint Site
F-02124 2016 Comprehensive Community Services (CCS) Program Survey Worksheet
F-021343G AFCSP Fiscal Report
F-02341A Wisconsin Children's Long-Term Support (CLTS) Waiver Provider Registration
F-02331 Caregiver Programs Customer Satisfaction Survey
F-02008 CLTS Waivers Certification Exam
F-01939 Wisconsin Medicaid Waiver Provider Registration
F-00577 Report Fraud
F-01361 ForwardHealth Provider Express Enrollment Change of Address
F-00917 Provider Enrollment Application Process
F-44160A WIC Plastic Cover for WIC ID Folder
F-24277 Informed Consent for Psychotropic Medication
F-83271 DHS Website Feedback
F-10110 Medicaid/BadgerCare Plus Eligibility Certification
F-21225 Program Participation System (PPS): B-3 Module
F-22540 Human Service Revenue Reporting - Expenditures by Revenue Source for Human Service Programs
F-02069 DHS Quarterly Report on Consumers Enrolled in CCS
F-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency
F-00119 Personal Care Agency Application for Approval
F-62461 Application for Critical Access Hospital Certification of Approval
F-62674 Home Health Agency License Application
F-62504 Community Substance Abuse Services (CSAS) or Mental Health Clinic Initial Certification Application
F-43021 Wisconsin Well Woman Program Multiple Sclerosis (MS) Report and Referral
F-44118 WIC Vendor Application
F-05102 Wisconsin Immunization Registry Exclusion
F-05023 Acknowledgement of Marital Child
F-05024 Voluntary Paternity Acknowledgement
F-05210 Name Change Request Within 1st Year
F-05027A Report of Citizenship
F-05027B Report of Naturalization
F-05029 Request To Withdraw Voluntary Paternity Acknowledgement
F-05032 Report of Birth Certificate Changes After Surrogate Birth
F-05033 Birth Amendment - Baptismal
F-05034 Birth Certificate Facts
F-05004 Birth Amendment - Affidavit
F-05035 Report Change Name, Sex Birth Certificate Surgical Procedure
F-05020 Paternity Order Due to Divorce - Judgement
F-05043 Notice of Removal - Corpse (Hospital, Nursing Home, Hospice)
F-05020A Paternity Order Due to Divorce - Custody
F-05044 Cause of Death Amendment
F-05021C Report of Legal Name Change - Confidential
F-05044C Coroner / Medical Examiner - Cause of Death Amendment
F-05021T Report of Legal Name Change - Tribal


Last Revised: May 22, 2018