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 Other Location
F-45014 Application for Radioactive Material License Authorizing the Use of Self Shielded Irradiators
F-45015 Application for Radioactive Material License for Broad Scope
F-45008 Application for Radioactive Material License for Medical Use
F-01827 Application for Reduction of Cost Share
F-44011 Application for Registration of Lead-Free or Lead-Safe Property
F-47097 Application for Registration of X-Ray Devices
F-22468 Application for Services Office for the Blind and Visually Impaired
F-02306 Application for Telecommunication Assistance Program (TAP)
F02029 Application for Wisconsin Certified Parent Peer Specialist Curriculum Trainer
F-22640 Application for Wisconsin Interpreting and Transliterating Assessment (WITA)
F-01268 Application to Conduct Intoxicated Driver Assessments, Tribal Treatment Facility
F-10126 Appoint, Change, or Remove an Authorized Representative
F-22599 Appointment of Authorized Representative for Supplemental Security Income (SSI)
F-01804 Appointment Results Wisconsin WIC Program
F-01331 Arbovirus Infection Follow-up
F-02052 Asbestos Abatement Project Log
F-44017 Asbestos Application - Individual
F-47242 Asbestos Certification Application
F-44002 Asbestos Certification Application - Company
F-00039 Asbestos Course Accreditation - Initial
F-00040 Asbestos Course Accreditation - Renewal
F-44016 Asbestos Occupant Protection Plan
F-00049 Asbestos Principal Instructor Application
F-00041 Asbestos Project Notification
F-20980 Assessment / Supplement to the Long Term Care Functional Screen
F-20817 Assessment Worksheet for Natural Residential Setting
F-20817A Assessment Worksheet for Natural Residential Setting - for Individuals with Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses
F-01944 Assessment, Feedback, Incentives, eXchange (AFIX) Adult Immunization Questionnaire
F-80476 Asset Transfer
F-00158 Assisted Living Administrator Training Course - Application for Training Curriculum
F-00157 Assisted Living Administrator Training Course - Trainer Approval Application
F-02208 Assisted Living Facility Self-Report
F-62548 Assisted Living Facility Waiver, Approval, Variance, or Exception Request
F-02111 Assisted Living – Fit and Qualified Application for Community-Based Residential Facilities and Adult Family
F-01406 Asthma Care (Release of Information )
F-01408 Asthma Control Summary
F-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency
F-00286 Attestation to Administer Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections
F-80479 Audit Confirmation Request
F-40057 Authorization and Permission For Release of Information to Wisconsin Birth Defects Prevention and Surveillance System and Early Childhood Program
F-00340 Authorization and Release - Photograph, Video, and/or Audio Recording
F-00086 Authorization for Final Disposition
F-22565 Authorization for Recoupment Caretaker Supplement
F-42016 Authorization for Release of Confidential HIV Test Results
F-22564 Authorization for Retroactive Caretaker Supplement (CTS)
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB)
F-01829 Authorization to Receive and Disclose Information - AIDS/HIV Drug Assistance and Insurance Assistance Programs
F-00048 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s)
F-00051 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Varicella, Meningococcal Conjugate (MCV4) Vaccine(s)

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Last Revised: May 22, 2018