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-00140 Attestation and Acknowledgement for Provisional Approval as a Personal Care Agency DQA
F-80479 Audit Confirmation Request DES
F-40057 Authorization and Permission For Release of Information to Wisconsin Birth Defects Prevention and Surveillance System and Early Childhood Program DPH
F-00340 Authorization and Release - Photograph, Video, and/or Audio Recording OS
F-00086 Authorization for Final Disposition DPH
F-22565 Authorization for Recoupment Caretaker Supplement DMS
F-42016 Authorization for Release of Confidential HIV Test Results DPH
F-22564 Authorization for Retroactive Caretaker Supplement (CTS) DMS
F-62308 Authorization to Accept Personal Service and Receive Registered and Certified Mail DQA
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB) DMS
F-01829 Authorization to Receive and Disclose Information - AIDS/HIV Drug Assistance and Insurance Assistance Programs DPH
F-00048 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Meningococcal Conjugate (MCV4) and/or Human Papilloma Virus (HPV) Vaccine(s) DPH
F-00051 Authorization To Receive Tetanus, diphtheria, acellular pertussis (Tdap), Varicella, Meningococcal Conjugate (MCV4) Vaccine(s) DPH
F-42029 Authorization to Receive Tetanus-Diphtheria-Acellular Pertussis (Tdap) and/or Varicella Vaccine DPH
F-42030 Authorization to Receive Tetanus-Diphtheria-Acellular Pertussis (Tdap) Vaccine DPH
F-00101 Authorization to Request Birth Records DMS
F-20987 Authorized Representative Designation Medicaid Community Waiver Programs DMS
F-02118 Authorized Signer Designation for Access to PPS and FSIA DMS
F-01352 Background Check Appeal Request - IRIS Program DMS
F-82064 Background Information Disclosure (BID) DQA
F-82069 Background Information Disclosure (BID) Appendix Instructions for License Holders and Non Client Residents in DQA-Regulated Facilities DQA
F-01246 Background Information Disclosure Addendum—IRIS DMS
F-10115 BadgerCare Plus / Medicaid Health Insurance Information DMS
F-10182 BadgerCare Plus Application Packet DMS
F-10185 BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication DMS
F-11309 BadgerCare Plus Express Enrollment for Children Provider Certification OIG
F-11268 BadgerCare Plus Express Enrollment for Pregnant Women Provider Certification OIG
F-10184 BadgerCare Plus Former Foster Care Youth (FFCY) DMS
F-12085 BadgerCare Plus HMO Program HMO Enrollment Choice DMS
F-13025 BadgerCare Plus Premium Employer Wage Withholding and Instructions DMS
F-10139 BadgerCare Plus Premium Information / Payment DMS
F-13026 BadgerCare Plus Premium Member / Employer Electronic Funds Transfer and Instructions DMS
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application DMS
F-10081 BadgerCare Plus – Express Enrollment for Pregnant Women Application DMS
F-01726 Basic Equipment List for Nurse Aide Training Programs DQA
F-01346 Behavior Monitoring Record-Model DPH
F-62504 Behavioral Health Certification Section: Initial Certification Application DQA
F-00922 Behavioral Health Integrated Care Health Home Certification Application DMS
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances DQA
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records DQA
F-02412 BioSense Platform Organization Security and Confidentiality Policy Agreement DPH
F-02413 BioSense Platform User Security and Confidentiality Agreement DPH
F-05004 Birth Amendment - Affidavit DPH
F-05033 Birth Amendment - Baptismal DPH
F-01427 Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting DMS
F-01428 Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP) DMS
F-22550 Birth to 3 Program Parental Cost Share DMS
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information DMS
F-00017 Blood Lead Lab Reporting DPH
F-01153 Breast Pump Order DMS

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Last Revised: March 26, 2019