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 Other Location
F-47141 Emergency Medical Technician-Paramedic Training Permit Application
F-00551 Emergency Mental Health Service Program Initial Certification Application - DHS 34
F-00571 Emergency Mental Health Service Program Recertification Application - DHS 34
F-00545 Emergency Outpatient Service Initial Certification Application - DHS 75.05
F-01651 Employee Information
F-22559 Employee Training Acknowledgement - Legal Restriction on Tobacco Sales to Minors
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information
F-10146 Employer Verification of Earnings
F-80976 Employment and Education History Summary
F-82006 Employment Application and Resume
F-00568 EMS Board Sub-Committee Appointment Application
F-02205 EMS Instructor II Evaluation
F-47489 EMS Patient Care Worksheet
F-00114 EMS Service Director License Proxy for Individuals
F-00987B EMS Service Operational Plan Advanced Skills Addendum (Advanced)
F-00987E EMS Service Operational Plan Advanced Skills Addendum (Critical Care)
F-00987C EMS Service Operational Plan Advanced Skills Addendum (First Responder)
F-00987A EMS Service Operational Plan Advanced Skills Addendum (Intermediate)
F-00987D EMS Service Operational Plan Advanced Skills Addendum (Paramedic)
F-00987 EMS Service Operational Plan, Advanced Skills Addendum (Basic)
F-47463B EMT - Basic Operational Plan Components
F-47482 EMT Training Center Certification Application
F-21334 Encounter New User Request
F-11318 Enrollment Criteria for Partners and Providers to Provide Express Enrollment of Children in BadgerCare Plus
F-11317 Enrollment Criteria for Providers Express Enrollment of Pregnant Women, Children, and Individuals Requiring Family Planning-Only Services in BadgerCare Plus
F-01655 Enrollment Discrepancy Report
F-62296 Entrance Conference Checklist
F-40040 Envelope - Vendor and Integrity Unit #9
F-49027 Environmental Protection Agency (EPA) Official Water Lab Survey
F-13039 Estate Recovery Program (ERP) Disclosure
F-02026 Ethnicity and Race Selection
F-40096 eWIC Program Repayment Agreement
F-21063 Exception to Care Management / Support and Service Coordination Contact Requirements
F-01700 Exception-to-Policy Request (AIDS/HIV)
F-00943 Exhibit II - Tribal Work Plan
F-00401 Expedited Emergency Supply Request
F-01234 Explanation of Medical Benefits
F-69261 Extended / Partial Extended Survey Worksheet CMS-673
F-05103 Facts About Your Child's Birth Certificate
F-02389 Fall Medicare Training for Wisconsin Professionals
F-02390 Fall Medicare Training Participant Survey
F-02390 Fall Medicare Training Participant Survey
F-02107 Family Adult Day Care Center
F-62611 Family Adult Day Care Certification Standards Checklist
F-00395 Family Care / Family Care Partnership Prevocational Services Six-Month Progress Report and Service Plan
F-00221 Family Care / IRIS Member Requested Disenrollment or Transfer and Instructions
F-00046 Family Care Program - Enrollment
F-01284 Family Care, Family Care Partnership, and PACE Financial Reporting
F-02403 Family Care, Partnership, PACE, and IRIS Program Requested Disenrollment
F-02404 Family Care, Partnership, PACE, or IRIS Change Routing Instructions


Last Revised: May 22, 2018