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-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-40040 Envelope - Vendor and Integrity Unit #9 DPH
F-49027 Environmental Protection Agency (EPA) Official Water Lab Survey DPH
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
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 Out-of-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

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Last Revised: March 26, 2019