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-42029 Authorization to Receive Tetanus-Diphtheria-Accellular Pertussis (Tdap) and/or Varicella Vaccine
F-42030 Authorization to Receive Tetanus-Diphtheria-Accellular Pertussis (Tdap) Vaccine
F-00101 Authorization to Request Birth Records
F-20987 Authorized Representative Designation, Medicaid Community Waiver Programs
F-02118 Authorized Signer Designation for Access to PPS and FSIA
F-21077 Autism Treatment Services Criteria Checklist Instructions
F-01352 Background Check Appeal Request - IRIS Program
F-82064 Background Information Disclosure (BID)
F-82069 Background Information Disclosure (BID) Appendix Instructions for License Holders and Non Client Residents in DQA-Regulated Facilities
F-01246 Background Information Disclosure Addendum—IRIS
F-10115 BadgerCare Plus / Medicaid Health Insurance Information
F-10182 BadgerCare Plus Application Packet
F-10185 BadgerCare Plus Child Welfare Parent / Caretaker Relative (CWPC) Communication
F-11309 BadgerCare Plus Express Enrollment for Children Provider Certification
F-11268 BadgerCare Plus Express Enrollment for Pregnant Women Provider Certification
F-10184 BadgerCare Plus Former Foster Care Youth (FFCY)
F-12085 BadgerCare Plus HMO Program HMO Enrollment Choice
F-13025 BadgerCare Plus Premium Employer Wage Withholding and Instructions
F-10139 BadgerCare Plus Premium Information / Payment
F-13026 BadgerCare Plus Premium Member / Employer Electronic Funds Transfer and Instructions
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application
F-10081 BadgerCare Plus – Express Enrollment for Pregnant Women Application
F-01726 Basic Equipment List for Nurse Aide Training Programs
F-01346 Behavior Monitoring Record-Model
F-00922 Behavioral Health Integrated Care Health Home Certification Application
F-00273 Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances
F-00276 Behavioral Health Services Recertification Application - DHS 94 Patients Rights and Resolution of Patient Grievances DHS 92 Confidentiality of Treatment Records
F-05004 Birth Amendment - Affidavit
F-05033 Birth Amendment - Baptismal
F-05034 Birth Certificate Facts
F-01427 Birth to 3 Invitation to Early Intervention (EI) Team Eligibility Determination and Individualized Family Service Plan (IFSP) Meeting
F-01428 Birth to 3 Program Invitation to Individualized Family Service Plan Meeting (IFSP)
F-22550 Birth to 3 Program Parental Cost Share
F-00632 Birth to 3 Program System of Payments - Consent to Access Insurance and Authorization to Release Information
F-12023 Birth to Three Program Exemption Request Information and Instructions
F-00017 Blood Lead Lab Reporting
F-44764 Bracelet Inserts
F-01153 Breast Pump Order
F-01210B Budget Amendment Annual Verification (BAAV) Request
F-00714 Business Associate Agreement - County or Tribal Contract
F-00759 Business Associate Agreement - With Contract
F-01715 Calculating Expenses for a CLTS Foster Home Using Actual Expenses
F-01716 Calculating Expenses for a CLTS Foster Home Using the Uniform Foster Care Brochure
F-80477A Canteen Operations Analysis of Cash - GAAP Basis
F-80477B Canteen Operations Balance Sheet - GAAP Basis
F-80477 Canteen Operations Statement of Revenues / Expenses and Fund Equity Changes - GAAP Basis
F-80963 Capital Asset Changes / Deletion Record
F-80462 Capital Asset Summary
F-62281 Care Level Change Notice
F-62288 Care Level Determination Worksheet


Last Revised: May 22, 2018