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 Titlesort descending Division Other Location
F-02107A Family Adult Day Care Center – Established Provider Certification Application DQA
F-02107B Family Adult Day Care Center – Established Provider Certification Application Checklist DQA
F-02107C Family Adult Day Care Center – New Provider Certification Application DQA
F-02107D Family Adult Day Care Center – New Provider Certification Application Checklist DQA
F-62611 Family Adult Day Care Certification Standards Checklist DQA
F-00395 Family Care / Family Care Partnership Prevocational Services Six-Month Progress Report and Service Plan DMS
F-00221 Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions DPH
F-02558 Family Care Member County Notification DMS
F-00046 Family Care Program - Enrollment DPH
F-01284 Family Care, Family Care Partnership, and PACE Financial Reporting DMS
F-02403 Family Care, Partnership, PACE, and IRIS Program Requested Disenrollment DPH
F-02404 Family Care, Partnership, PACE, or IRIS Change Routing Instructions DPH
F-80783A Family Financial Questionnaire - County Use DES
F-11245 Family Planning Clinics or Agencies OIG
F-00356 Family Planning Only Services Authorization for Electronic Data Transfer of Application DMS
F-44819 Farmers Market Nutrition Program (FMNP) - Application for Farm Stand DPH
F-44800 Farmers Market Nutrition Program (FMNP) - Application for Farmers' Market Managers DPH
F-44746 Farmers Market Nutrition Program (FMNP) - Site Observation Worksheet DPH
F-40053 Farmers' Market Nutrition Program (FMNP) - Verification of Participation in Farmer Training DPH
F-11129A Federally Qualified Health Center Cost Report Completion Instructions DMS
F-11129B-H Federally Qualified Health Center Cost Report Forms OIG
F-11130 Federally Qualified Health Center Interim Report DMS
F-62690 Feeding Assistant Competency Evaluation Skills Examination - Handwashing DQA
F-62691 Feeding Assistant Competency Evaluation Skills Examination - Handwashing DQA
F-62693 Feeding Assistant Competency Evaluation Written Examination DQA
F-62694 Feeding Assistant Competency Evaluation Written Examination Answer Key DQA
F-62697 Feeding Assistant Training Certification of Completion DQA
F-62592 Feeding Assistant Training Program Annual Review Report DQA
F-62588 Feeding Assistant Training Program Application DQA
F-62692 Feeding Assistant Training Program Primary Instructor Application DQA
F-62688 Feeding Assistant Training Program Trainer Application DQA
F-00543A File Review Checklist DMS
F-00015 Final Occupancy Inspection Checklist DQA
F-02588 Financial Exploitation Tracking for Counties DPH
F-80130 Financial Information  DES
F-00407 Financial Records Request DMS
F-02439 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH
F-47478 First Responder / Emergency Medical Technician Application Electronic Addition to a Roster DPH
F-47477 First Responder / Emergency Medical Technician Certificate / License DPH
F-47181 First Responder Certification Card DPH
F-47463A First Responder Operational Plan Components DPH
F-00152A Fiscal Analysis Details for Pay Over the Medicaid Fee-for-Service Rate Request DMS
F-01293B Fiscal Employer Agent (FEA) Change Denial Letter DMS
F-01293C Fiscal Employer Agent (FEA) Change Effective Date Letter DMS
F-00161A Flowchart of Entity Investigation and Reporting Requirements for Caregiver Misconduct and Injuries of Unknown Source DQA
F-02011 Fluoride Mouth Rinse Program Annual Report DPH
F-02012 Fluoride Supplement Program Annual Report DPH
F-02491 FoodShare Buy and Make Food Separately DMS
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice DMS
F-01256 FoodShare Employment and Training (FSET) - Discuss FSET Participation DMS

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Last Revised: March 26, 2019