Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Number Title Division Other Locationsort descending
F-00169 Opting Out of Local Education Agency (LEA) and State Education Agency (SEA) Notification DMS
F-22554 Hearing Loss Certification Telecommunications Assistance Program (TAP) DPH
F-00021 HealthCheck Referral DMS
F-01208 IRIS Consultant Agency Quality Management Plan DMS
F-01222 WISEWOMAN Diagnostic and Hypertension Management Referral DPH
F-02260 Temporary QUEST Card Issuance Checklist DMS
F-02766 Residential Substance Use Disorder Treatment for BadgerCare Plus and Medicaid Members DMS
F-01068K General Pediatric Clinic - Elementary School Visit DMS
F-62608 Request for Use of Medical Restraints DMS
F-13148 HIPAA Privacy Access Request DMS
F-02061 Pharmacy Benefit Manager (PBM) Insurance Disclosure Onboarding DMS
F-02666 Prior Authorization Drug Attachment for Headache Agents, Acute Treatment DMS
F-62224 Nurse Aide Training Program – Notice of Substantial Change DQA
F-01938 Wisconsin EMS Paramedic Training Record - NCCP Paramedic Refresher Requirements DPH
F-02548 BadgerCare Plus Health Survey DMS
F-00926 Request for Use of Restraints, Isolation, or Protective Equipment as Part of a Behavior Support Plan - CLTS DMS
F-11078 Prior Authorization / Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Capsules and Tablets DMS
F-00580 Nursing Home Authorization for Access to Automated MDS 3.0 Section Q Referral Management System DMS
F-45022 Application for Material License DPH
F-10184 BadgerCare Plus Former Foster Care Youth (FFCY) DMS
F-01619 OARS Welcome Letter DCTS
F-02108D Adult Family Home – New Provider Licensure Application Checklist DQA
F-00439 Community Substance Abuse Services (CSAS) Emergency Outpatient Service Recertification Application - DHS 75.05 DQA
F-44125 Latent Tuberculosis Infection (LTBI) Follow-Up Report DPH
F-00989P Individualized Family Service Plan Team Signature (IFSP) DMS
F-02400B Client Transfer: Labels DQA
F-00301 2009 Wisconsin ACT 318 High Cost Mental Health Fund Application DCTS
F-40053 Farmers' Market Nutrition Program (FMNP) - Verification of Participation in Farmer Training DPH
F-01319 IRIS Involuntary Disenrollment Request DMS
F-01418 21-Day Monitoring Period Chart DPH
F-21336 Consent for Exchange of Information with Local Educational Agency DMS
F-02835 Opening Avenues to Reentry Success (OARS2) Informed Consent for Mental Health Evaluation, Treatment, and Community Reintegration Services DCTS
F-80881 Profile ID Request (CARS) DES
F-02107 Family Adult Day Care Center – Applicant Compliance Statement DQA
F-02741 Wisconsin Emergency Assistance Volunteer Registry (WEAVR): COVID-19 Staffing Request CRT
F-00123 Wisconsin Declaration of Domestic Partnership Application DPH
F-01196 Wisconsin Adult Cystic Fibrosis Program Financial Need Statement Cover Memo DMS
F-02108 Adult Family Home – Applicant Compliance Statement DQA
F-01697 Application for Farmers Market or Direct Marketing Farmer EBT FoodShare Payment Processing Equipment DMS
F-01197 Certification of Need for Specialized Medical Vehicle Transportation DMS
F-16024 FoodShare Notice of Disqualification DMS
F-01066 HealthCheck Infant's Food Record (Birth to 12 Months of Age) DMS
F-62504 Behavioral Health Certification Section: Initial Certification Application DQA
F01454G IRIS Program Withdrawal Letter – Cancelled DMS
F-02658 COVID-19 Testing DQA
F-00855 Medication Therapy Management Case Management Software Requirements DMS
F-62023 Report of Hours Worked - Registered Nurse / Day DQA
F-11039 Prior Authorization / Spell of Illness Attachment (PA/SOIA) DMS
F-01829 Authorization to Receive and Disclose Information - AIDS/HIV Drug Assistance and Insurance Assistance Programs DPH
F-02574 Wisconsin Assistive Technology Advisory Council Application DPH


Last Revised: March 23, 2021