Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Numbersort descending Title Division Other Location
F-01729 Nonprobate Asset / Property Disclosure DMS
F-01735 CLIA Laboratory Test Methodology Report DQA
F-01744 Vaccine Restitution Policy - Agreement DPH
F-01749 Prior Authorization Drug Attachment for Hypoglycemics, Insulin – Long-Acting DMS
F-01761 Intoxicated Driver Program Self-Evaluation DCTS
F-01763 The Emergency Food Assistance Program (TEFAP) - Review Findings for Food Pantries, Soup Kitchens and Shelters DPH
F-01764 The Emergency Food Assistance Program (TEFAP) - Food Pantry Review DPH
F-01765 TEFAP Food Pantry Self-Assessment Tool DPH
F-01766 The Emergency Food Assistance Program (TEFAP) - Shelter Review DPH
F-01767 TEFAP Shelter Self-Assessment Tool DPH
F-01768 The Emergency Food Assistance Program - Soup Kitchen Review DPH
F-01769 TEFAP Soup Kitchen Self-Assessment DPH
F-01781 Immunization Program Functional Exercise 2018-2020 (BP1 Supplemental) DPH
F-01785 Letter - 40-Hour Health and Safety Assurance Policy Exception Request Denial DMS
F-01788 Certification Regarding Debarment and Suspension DES
F-01803 Maternal Referral / Communication Wisconsin WIC Program DPH
F-01804 Appointment Results Wisconsin WIC Program DPH
F-01805 Patient Rights for Victims of Sexual Assault, Human Trafficking Involving a Commercial Sex Act, or Child Sexual Abuse DQA
F-01812D Current Occupancy Test Worksheet for Billing Medicaid Bed-Hold Days DMS
F-01814 County Agency Children’s Community Options Program (CCOP) Five-Year Plan DMS
F-01821 WIC Authorized Infant Formula Supplier Application DPH
F-01827 Application for Reduction of Cost Share DMS
F-01829 Authorization to Receive and Disclose Information - AIDS/HIV Drug Assistance and Insurance Assistance Programs DPH
F-01844 Wisconsin Notification of Death – Accounting of Estate Funds DMS
F-01885 Requesting State Trauma Registry Access DPH
F-01891 New Employment Reporting – FoodShare Employment and Training (FSET) Program DMS
F-01894 Vendor Overpayment Findings Letter DMS
F-01915 Marketplace or Indicator Gap Filling Eligibility Determinations Supplemental Letter DMS
F-01915A Member Request Gap Filling Eligibility Determinations Supplemental Letter DMS
F-01924 Public Comment on Rulemaking Project OLC
F-01930 Minority Health Advisory Group Nomination and Agreement DPH
F-01938 Wisconsin EMS Paramedic Training Record - NCCP Paramedic Refresher Requirements DPH
F-01942 Long-Term Care Functional Screen (LTC-FS) - Annual Deadline DMS
F-01942A LTC FS - Diagnosis Verification Letter DMS
F-01942B LTC FS - Request Letter DMS
F-01942C LTC FS - Release of Information Authorization DMS
F-01942D LTC FS - Change in Condition - Release of Information Authorization DMS
F-01947 IRIS Participant Education Manual: Acknowledgement DMS
F-01950 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn’s Disease and Ulcerative Colitis DMS
F-01951 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis DMS
F-01952 Prior Authorization Drug Attachment for Cytokine and CAM Antagonist Drugs for DIRA, Giant Cell Arteritis, NOMID, and nr-axSpA DMS
F-01954 Wisconsin EMS Training Record NCCP AEMT Refresher Requirements DPH
F-01955 Wisconsin EMS Training Record Critical Care Paramedic Refresher Record DPH
F-01985 Self-Employment Income Worksheet: Personal Capital Gains or Losses (Schedule D) DMS
F-01989 Renewal Application – Individual Lead Disciplines DPH
F-01991 ACCESS Application Cover Sheet – Milwaukee Enrollment Services (MilES) DMS
F-01997 Children's Community Options (CCOP) Reconciliation Packet DMS
F-01999 Foster Grandparent Program: State Match Funding Application DPH
F-01999A Retired Senior Volunteer Program: State Match Funding Application DPH
F-01999B Senior Companion Program: State Match Funding Application DPH

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Last Revised: March 23, 2021