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 Numbersort descending Title Division Other Location
F-45012 Application for a Radioactive Material License for a Commercial Radiopharmacy DPH
F-45013 Application for a Radioactive Material License Authorizing the Use of Industrial Radiography DPH
F-45014 Application for Radioactive Material License Authorizing the Use of Self Shielded Irradiators DPH
F-45015 Application for Radioactive Material License for Broad Scope DPH
F-45016 Application for a Radioactive Material License for Academic, Research and Development and Other Licenses of Limited Scope DPH
F-45017 Application for Radioactive Material License Authorizing the Use of Sealed Sources DPH
F-45019 Reciprocity Privileges Checklist DPH
F-45020 Cumulative Occupational Exposure History DPH
F-45021 Generally Licensed Device Inspection by Mail DPH
F-45022 Application for Material License DPH
F-45023 Certificate - Use of Depleted Uranium under General License DPH
F-45025 Patient Questionnaire DPH
F-45029 School Food Safety Program Inspection Report DPH
F-45029i Instructions For School Food Safety Plan DPH
F-45032 License, Permit or Registration - Radiation Only DPH
F-45038 Wisconsin Mercury Exposure Study DPH
F-47020 Sink Requirements DPH
F-47097 Application for Registration of X-Ray Devices DPH
F-47119 Ambulance Report DPH
F-47125 Emergency Medical Technician - Intermediate Training Permit Application DPH
F-47128 Emergency Medical Technician - Basic Training Permit Application DPH
F-47141 Emergency Medical Technician-Paramedic Training Permit Application DPH
F-47181 First Responder Certification Card DPH
F-47198 Noise Exposure Sampling Sheet DPH
F-47204 Hazard Summary Form DPH
F-47219 Agent Change Sheet DPH
F-47236 Operations and Maintenance Certificate DPH
F-47242 Asbestos Certification Application DPH
F-47247 Ambulance Attendant License/Permit Renew DPH
F-47255 Emergency Medical Services Program Municipal Signature and Population Verification DPH
F-47300 Ambulance Run Report (page 3) Skills /  Extended Comments DPH
F-47463 Emergency Medical Service (EMS) Provider Application and Operational Plan DPH
F-47463A First Responder Operational Plan Components DPH
F-47463B EMT - Basic Operational Plan Components DPH
F-47463C Intermediate Technician Operational Plan Components DPH
F-47463D Intermediate Operational Plan Components DPH
F-47463E Paramedic Operational Plan Components DPH
F-47464 Emergency Medical Technician - Basic IV Training Permit Application DPH
F-47470 Change of EMS Medical Director DPH
F-47471 Emergency Medical Technician Verification of Licensure DPH
F-47472 Emergency Medical Technician (EMT) License / First Responder Certification Renewal Application DPH
F-47477 First Responder / Emergency Medical Technician Certificate / License DPH
F-47478 First Responder / Emergency Medical Technician Application Electronic Addition to a Roster DPH
F-47479 Trauma Care Facility Classification Application DPH
F-47482 EMT Training Center Certification Application DPH
F-47489 EMS Patient Care Worksheet DPH
F-49027 Environmental Protection Agency (EPA) Official Water Lab Survey DPH
F-49357 Personal Diabetes Care Record DPH
F-60287 Community-Based Residential Facility (CBRF) Initial Licensure Application DQA
F-60289 Waiver or Variance Request - Community Mental Health and Substance Abuse Programs DQA

Pages

Last Revised: March 26, 2019