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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-03454 Prior Authorization / Behavioral Health Day Treatment Attachment (PA/BHDTA) (PDF) DMS English 10/2026 No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) (Word) DMS English 12/2019 No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) (PDF) DMS English 12/2019 No
F-01629A Prior Authorization / Behavioral Treatment Attachment (PA/BTA) Completion Instructions (PDF) DMS English 12/2019 No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) (PDF) DMS English 07/2012 No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) (Word) DMS English 07/2012 No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) (PDF) DMS English 08/2015 No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) (Word) DMS English 08/2015 No
F-11096A Prior Authorization / Care Plan Attachment (PA/CPA): Completion Instructions (PDF) DMS English 09/2015 No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) (PDF) DMS English 12/2019 No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) (Word) DMS English 12/2019 No
F-11040A Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) Instructions (PDF) DMS English 12/2019 No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) (Word) DMS English 04/2026 No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) (PDF) DMS English 04/2026 No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format (PDF) DMS English 01/2019 No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format (Word) DMS English 01/2019 No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services (PDF) DMS English 02/2020 No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services (Word) DMS English 02/2020 No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips (PDF) DMS English 12/2013 No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips (Word) DMS English 12/2013 No
F-00239A Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips Completion Instructions (PDF) DMS English 07/2015 No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) (Word) DMS English 08/2026 No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) (PDF) DMS English 08/2026 No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) (Word) DMS English 07/2012 No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) (PDF) DMS English 07/2012 No
F-11088A Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA): Completion Instructions (PDF) DMS English 07/2012 No
F-11044 Prior Authorization / Home Health Therapy Attachment (PA/HHTA) (Word) DMS English 08/2026 No
F-11044 Prior Authorization / Home Health Therapy Attachment (PA/HHTA) (PDF) DMS English 08/2026 No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) (PDF) DMS English 12/2019 No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) (Word) DMS English 12/2019 No
F-11036A Prior Authorization / In-Home Treatment Attachment (PA / ITA): Completion Instructions (PDF) DMS English 12/2019 No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) (Word) DMS English 07/2012 No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) (PDF) DMS English 07/2012 No
F-11033A Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) Completion Instructions (PDF) DMS English 10/2008 No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) (PDF) DMS English 08/2026 No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) (Word) DMS English 08/2026 No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) (PDF) DMS English 07/2012 No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) (Word) DMS English 07/2012 No
F-11019A Prior Authorization / Physician Otological Report (PA/POR) Completion Instructions (PDF) DMS English 07/2012 No
F-11305 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease (PDF) DMS English 01/2016 No
F-11305A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease: Completion Instructions (PDF) DMS English 01/2016 No
F-11307 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis (PDF) DMS English 12/2012 No
F-11307A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis: Completion Instructions (PDF) DMS English 07/2015 No
F-11308 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis (PDF) DMS English 12/2012 No
F-11308A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis: Completion Instructions (PDF) DMS English 07/2015 No
F-00694A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ulcerative Colitis Completion Instructions (PDF) DMS English 07/2015 No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents (PDF) DMS English 09/2019 No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents (Word) DMS English 09/2019 No
F-11097A Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents: Completion Instructions (PDF) DMS English 07/2015 No
F-00080 Prior Authorization / Preferred Drug List (PA/PDL) for Symlin (PDF) DMS English 10/2011 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