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 Title Division Other Locationsort descending
F-21225 Program Participation System (PPS): B-3 Module DMS
F-10110 Medicaid/BadgerCare Plus Eligibility Certification DMS
F-83271 DHS Website Feedback OS
F-02663 Letterhead – EVV Personal Identification Number (PIN) DMS
F-24277 Informed Consent for Psychotropic Medication DCTS
F-44160A WIC Plastic Cover for WIC ID Folder (order in multiples of 200) DPH
F-16066 FoodShare Wisconsin Income Change Report DMS
F-10101 Wisconsin Medicaid for the Elderly, Blind or Disabled Application Packet DMS
F-62690 Feeding Assistant Competency Evaluation Skills Examination - Handwashing DQA
F-62691 Feeding Assistant Competency Evaluation Skills Examination - Handwashing DQA
F-62693 Feeding Assistant Competency Evaluation Written Examination DQA
F-62694 Feeding Assistant Competency Evaluation Written Examination Answer Key DQA
F-62697 Feeding Assistant Training Certification of Completion DQA
F-00917 Provider Enrollment Application Process DMS
F-01361 ForwardHealth Provider Express Enrollment Change of Address DMS
F-00577 Report Fraud OIG
F-02008 CLTS Waivers Certification Exam DMS
F-02389 Fall Medicare Training for Wisconsin Professionals DPH
F-01684 Community Mental Health Allocation (CMHA) Report DCTS
F-00251 Mental Health Block Grant Community Aids Allocation Report DCTS
F-62592 Feeding Assistant Training Program Annual Review Report DQA
F-02331 Caregiver Programs Customer Satisfaction Survey DPH
F-62500 Health Care Facility Fire Report DQA
F-02341 County Waiver Agency Contact: Wisconsin Children's Long-Term Support (CLTS) Waiver Provider SharePoint Site DMS
F-00607 Complaint Intake Survey DQA
F-02390 Fall Medicare Training Participant Survey DPH
F-02426 DQA Misconduct Incident Reporting (MIR) System Account Registration Survey DQA
F-02524 Agent Training Request DCTS
F-02499 Nonresidential Group Supported Employment Site Survey DMS
F-021343G AFCSP Fiscal Report DPH
F-02534 CLTS Waiver Fiscal Agent and Fiscal Intermediary Registration DMS
F-21343 Alzheimer's Family and Caregiver Support Program (AFCSP) Budget Report DPH
F-02590 Ongoing Review of Nonresidential Group Supported Employment Site Surveys DMS
F-62593 Nurse Aide Training Program Annual Report DQA
F-02672 CLTS Waiver Sole Proprietor Registration DMS
F-22567 Substance Abuse Prevention Treatment Block Grant Annual Reporting DCTS
F-02124 Comprehensive Community Services (CCS) Program Survey Worksheet DCTS
F-02388 MIPPA Grant Agency Application DPH
F-02341A Wisconsin Children's Long-Term Support (CLTS) Waiver Provider Registration DMS
F-02390 Fall Medicare Training Participant Survey DPH
F-02069 DHS Quarterly Report on Consumers Enrolled in CCS DCTS
F-02714 ADRC Professional Training Participant Survey DPH
F-47471 Emergency Medical Technician Verification of Licensure DPH
F-47472 Emergency Medical Technician (EMT) License / First Responder Certification Renewal Application DPH
F-47477 First Responder / Emergency Medical Technician Certificate / License DPH
F-47478 First Responder / Emergency Medical Technician Application Electronic Addition to a Roster DPH
F-47181 First Responder Certification Card DPH
F-47247 Ambulance Attendant License/Permit Renew DPH
F-47255 Emergency Medical Services Program Municipal Signature and Population Verification DPH
F-02439 Financial Reporting for Local and Tribal Health Agencies for Communicable Disease Funds DPH

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Last Revised: March 26, 2019