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BadgerCare Plus Forms

Below is a list of all BadgerCare Plus forms. 

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned number Title Division Language Release date Available to order
F-01159A Commercial Other Coverage Discrepancy Report Instructions (PDF) DMS English 04/2017 No
F-13073 Compound Drug Claim (PDF) DMS English 04/2017 No
F-13073 Compound Drug Claim (Word) DMS English 04/2017 No
F-13073A Compound Drug Claim: Completion Instructions (PDF) DMS English 02/2025 No
F-01270 Comprehensive Community Services Non-Traditional Approval (Word) DMS English 07/2014 No
F-01270 Comprehensive Community Services Non-Traditional Approval (PDF) DMS English 07/2014 No
F-01068M Confidential Health Survey (PDF) DMS English 08/2019 No
F-01068M Confidential Health Survey (Word) DMS English 08/2019 No
F-01068MS Confidential Health Survey, Spanish (PDF) DMS Spanish 08/2019 No
F-01068MS Confidential Health Survey, Spanish (Word) DMS Spanish 08/2019 No
DMS-1000 Consent for Sterilization (PDF) DMS English 06/2025 No
DMS-1000S Consent for Sterilization Form, Spanish (PDF) DMS Spanish 06/2025 No
F-16104A Customer Experience Survey (HTML) DMS English, Hmong, Spanish 12/2025 No
F-16104 Customer Experience Survey (PDF) DMS English 12/2025 Yes
F-16104H Customer Experience Survey, Hmong (PDF) DMS Hmong 12/2025 No
F-16104S Customer Experience Survey, Spanish (PDF) DMS Spanish 12/2025 No
F-00020 Drug Addition Review Request (Word) DMS English 02/2025 No
F-00020 Drug Addition Review Request (PDF) DMS English 02/2025 No
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil (PDF) DMS English 01/2019 No
F-00079A Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil Instructions (PDF) DMS English 01/2019 No
F-00246 Employer Health Insurance Verification Individual Follow-Up Health Insurance Information (PDF) DMS English 06/2019 No
F-10146 Employer Verification of Earnings (Word) DMS English 04/2026 No
F-10146A Employer Verification of Earnings: Proof of Employment (Word) DMS English 06/2020 No
F-01234 Explanation of Medical Benefits (Word) DMS English 04/2018 No
F-01234 Explanation of Medical Benefits (PDF) DMS English 04/2018 No
F-02493 ForwardHealth Prior Authorization Speech-Generating Device Purchase Recommendation Attachment (PDF) DMS English 07/2019 No
F-02493 ForwardHealth Prior Authorization Speech-Generating Device Purchase Recommendation Attachment (Word) DMS English 07/2019 No
F-02493A ForwardHealth Prior Authorization Speech-Generating Device Purchase Recommendation Attachment Instructions (PDF) DMS English 07/2019 No
F-02494 ForwardHealth Prior Authorization Speech-Generating Device Skills and Needs Profile Attachment (PDF) DMS English 07/2019 No
F-02494 ForwardHealth Prior Authorization Speech-Generating Device Skills and Needs Profile Attachment (Word) DMS English 07/2019 No
F-02494A ForwardHealth Prior Authorization Speech-Generating Device Skills and Needs Profile Attachment Instructions (PDF) DMS English 07/2019 No
F-01068F General Pediatric Clinic - 12 Month Visit (PDF) DMS English 08/2019 No
F-01068F General Pediatric Clinic - 12 Month Visit (Word) DMS English 08/2019 No
F-01068G General Pediatric Clinic - 15 Month Visit (PDF) DMS English 08/2019 No
F-01068G General Pediatric Clinic - 15 Month Visit (Word) DMS English 08/2019 No
F-01068H General Pediatric Clinic - 18 Month Visit (PDF) DMS English 08/2019 No
F-01068H General Pediatric Clinic - 18 Month Visit (Word) DMS English 08/2019 No
F-01068I General Pediatric Clinic - 24 Month Visit (Word) DMS English 08/2019 No
F-01068I General Pediatric Clinic - 24 Month Visit (PDF) DMS English 08/2019 No
F-01068A General Pediatric Clinic - 3 to 4 Week Visit (Word) DMS English 08/2019 No
F-01068A General Pediatric Clinic - 3 to 4 Week Visit (PDF) DMS English 08/2019 No
F-01068C General Pediatric Clinic - 4 Month Visit (Word) DMS English 08/2019 No
F-01068C General Pediatric Clinic - 4 Month Visit (PDF) DMS English 08/2019 No
F-01068D General Pediatric Clinic - 6 Month Visit (PDF) DMS English 08/2019 No
F-01068D General Pediatric Clinic - 6 Month Visit (Word) DMS English 08/2019 No
F-01068B General Pediatric Clinic - 6 to 8 Week Visit (PDF) DMS English 08/2019 No
F-01068B General Pediatric Clinic - 6 to 8 Week Visit (Word) DMS English 08/2019 No
F-01068E General Pediatric Clinic - 9 Month Visit (Word) DMS English 08/2019 No
F-01068E General Pediatric Clinic - 9 Month Visit (PDF) DMS English 08/2019 No
F-01068K General Pediatric Clinic - Elementary School Visit (PDF) DMS English 08/2019 No

DHS is required under Wis. Stat. § 15.04(1) to establish and maintain a forms management program, appoint a forms officer, and establish and maintain a numbering and filing system for official forms.

Glossary

 
Last revised September 30, 2025