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-01410 Education - Medication Summary - Part A DPH
F-01411 Education - Medication Summary - Part B DPH
F-21150 Elder Adults/Adults-at-Risk Agency Conflict of Interest Notification and Transfer of Investigation Powers DPH
F-44763 Emergency Care Do Not Resuscitate Order (DNR) DPH
F-47463 Emergency Medical Service (EMS) Provider Application and Operational Plan DPH
F-00646 Emergency Medical Service Training Center Training Permit Eligibility Certification DPH
F-02570 Emergency Medical Services (EMS) E-Licensing Service Demographic Information DPH
F-00567 Emergency Medical Services Complaint DPH
F-47255 Emergency Medical Services Program Municipal Signature and Population Verification DPH
F-01660 Emergency Medical Staff Patient Tracking Pilot Program Commitment, Wisconsin Healthcare Emergency Preparedness Program (WHEPP) DPH
F-47472 Emergency Medical Technician (EMT) License / First Responder Certification Renewal Application DPH
F-47464 Emergency Medical Technician - Basic IV Training Permit Application DPH
F-47128 Emergency Medical Technician - Basic Training Permit Application DPH
F-47125 Emergency Medical Technician - Intermediate Training Permit Application DPH
F-47471 Emergency Medical Technician Verification of Licensure DPH
F-47141 Emergency Medical Technician-Paramedic Training Permit Application DPH
F-00551 Emergency Mental Health Service Program Initial Certification Application - DHS 34 DQA
F-00571 Emergency Mental Health Service Program Recertification Application - DHS 34 DQA
F-00545 Emergency Outpatient Service Initial Certification Application - DHS 75.05 DQA
F-22559 Employee Training Acknowledgement - Legal Restriction on Tobacco Sales to Minors DPH
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information DMS
F-10146 Employer Verification of Earnings DMS
F-80976 Employment and Education History Summary DES
F-82006 Employment Application and Resume DES
F-00568 EMS Board Sub-Committee Appointment Application DPH
F-47489 EMS Patient Care Worksheet DPH
F-00114 EMS Service Director License Proxy for Individuals DPH
F-00987B EMS Service Operational Plan Advanced Skills Addendum (Advanced) DPH
F-00987E EMS Service Operational Plan Advanced Skills Addendum (Critical Care) DPH
F-00987C EMS Service Operational Plan Advanced Skills Addendum (First Responder) DPH
F-00987A EMS Service Operational Plan Advanced Skills Addendum (Intermediate) DPH
F-00987D EMS Service Operational Plan Advanced Skills Addendum (Paramedic) DPH
F-00987 EMS Service Operational Plan, Advanced Skills Addendum (Basic) DPH
F-47463B EMT - Basic Operational Plan Components DPH
F-47482 EMT Training Center Certification Application DPH
F-21334 Encounter New User Request DMS
F-11318 Enrollment Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus OIG
F-11317 Enrollment Criteria for Providers Express Enrollment of Pregnant Women, Children, and Individuals Requiring Family Planning-Only Services in BadgerCare Plus OIG
F-01655 Enrollment Discrepancy Report DMS
F-62296 Entrance Conference Checklist DQA
F-13039 Estate Recovery Program (ERP) Disclosure DMS
F-02026 Ethnicity and Race Selection DPH
F-40096 eWIC Program Repayment Agreement DPH
F-01700 Exception-to-Policy Request (AIDS/HIV) DPH
F-00943 Exhibit II - Tribal Work Plan OS
F-01234 Explanation of Medical Benefits DMS
F-05103 Facts About Your Child's Birth Certificate DPH
F-02389 Fall Medicare Training for Wisconsin Professionals DPH
F-02390 Fall Medicare Training Participant Survey DPH
F-02107 Family Adult Day Care Center – Applicant Compliance Statement DQA


Last Revised: March 26, 2019