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 Other Locationsort descending
F-20817A Assessment Worksheet for Natural Residential Setting - for Individuals with Serious and Persistent Mental Illness and/or Alcohol and Other Drug Dependent Diagnoses
F-80188 Check Distribution / Attachments
F-13393 Trading Partner 835 Designation
F-62579 Post Survey Questionnaire
F-11309 BadgerCare Plus Express Enrollment for Children Provider Certification
F-00519 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Initial Certification Application - DHS 75.07
F-11037 Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA)
F-00367G Age-Specific ADL / IADL Answer Choices for Children's Long-Term Support Programs Age: 4 - 6 Years
F-10145 Agency Position on the Medicaid Eligibility Quality Control (MEQC) Error Finding
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information
F-01924 Public Comment on Rulemaking Project
F-00098 Summary of Information Letter
F-01984 Self-Employment Income Worksheet: Sole Proprietorship (Schedule C or Schedule C-EZ)
F-62157 Living Unit Direct Care Staff Report - Evening Shift
F-00193 Pediatric Referral / Communication Wisconsin WIC Program
F-01620 Opening Avenues to Reentry Success (OARS) Informed Consent for Mental Health Evaluation, Treatment and Community Reintegration Services
F-44763 Emergency Care - Do Not Resuscitate Order (DNR)
F-43006 Health Care Employer Assurance for J-1 Visa Waiver Applications
F-01284 Family Care, Family Care Partnership, and PACE Financial Reporting
F-01201A IRIS Participant - Hired Worker Relationship Identification
F-01068B General Pediatric Clinic - 6 to 8 Week Visit
F-00004 Health and Employment Counseling Application
F-01569 IRIS Consultant Agency (ICA) Transfer Checklist
F-01205K IRIS Participant Education: Annual Health Care Information
F-02441 Wisconsin Interpreting and Transliterating Assessment (WITA) Permanent Status Request
F-01389B MHSIP Family Satisfaction Survey
F-22433 Request for a Hearing, Wisconsin Birth to 3 Program
F-82003 Denial of Researcher Access To Health Care Records
F-00913 Annual Survey of Nursing Homes
F-13153 Wisconsin Chronic Disease Program (WCDP) HIPAA Privacy Authorization for Use or Disclosure
F-00603 PPS (Program Participation System) Core Module
F-11129B-H Federally Qualified Health Center Cost Report Forms
F-00470 Community Substance Abuse Services (CSAS) Day Treatment Service Recertification Application - DHS 75.12
F-00334 Money Follows the Person (MFP) - Participant Reporting
F-02385 Vaccine Accountability -Vaccine Preventable Disease: Tetanus
F-02241 Hepatitis A Worksheet Confirmed and Suspected Cases
F-62692 Feeding Assistant Training Program Primary Instructor Application
F-02117 Home and Community-Based Settings - Adult Residential Provider Assessment
F-62457 Request for Permission to Start Construction for Footings and Foundations
F-02011 Fluoride Mouthrinse Program Annual Report
F-62019 License Application for Nursing Home, Intermediate Care Facility – Individuals with Intellectual Disabilities (ICF-IID), or Institute for Mental Disease (IMD)
F-11020 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1)
F-45022 Application for Material License
F-10115 BadgerCare Plus / Medicaid Health Insurance Information
F-00191A Certified Outpatient Clinic Request for a School Branch Office
F-01252 FoodShare Employment and Training (FSET) - Initial Appointment
F-01827 Application for Reduction of Cost Share
F-01655 Enrollment Discrepancy Report
F-00989 Individualized Family Service Plan (IFSP)
F-42001 Tuberculosis Suspect Case Data

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Last Revised: May 22, 2018