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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-01749 Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting (PDF) DMS English 07/2024 No
F-01749 Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting (Word) DMS English 07/2024 No
F-01749A Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting Instructions (PDF) DMS English 07/2024 No
F-00162 Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids (PDF) DMS English 07/2024 No
F-00162 Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids (Word) DMS English 07/2024 No
F-00162A Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids Instructions (PDF) DMS English 07/2024 No
F-02505 Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors (PDF) DMS English 07/2024 No
F-02505 Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors (Word) DMS English 07/2024 No
F-02505A Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors Instructions (PDF) DMS English 07/2024 No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil (PDF) DMS English 01/2018 No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil (PDF) DMS English 07/2018 No
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions (PDF) DMS English 01/2018 No
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions (PDF) DMS English 07/2018 No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® (PDF) DMS English 01/2017 No
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents (PDF) DMS English 07/2023 No
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents (Word) DMS English 07/2023 No
F-00805A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Instructions (PDF) DMS English 07/2023 No
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons (PDF) DMS English 07/2023 No
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons (Word) DMS English 07/2023 No
F-03175A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons Instructions (PDF) DMS English 07/2023 No
F-03384 Prior Authorization Drug Attachment for Voquezna Tablets (PDF) DMS English 07/2026 No
F-03384 Prior Authorization Drug Attachment for Voquezna Tablets (Word) DMS English 07/2026 No
F-03384A Prior Authorization Drug Attachment for Voquezna Tablets Instructions (PDF) DMS English 07/2026 No
F-02573 Prior Authorization Drug Attachment for Wakix (PDF) DMS English 10/2024 No
F-02573 Prior Authorization Drug Attachment for Wakix (Word) DMS English 10/2024 No
F-02573A Prior Authorization Drug Attachment for Wakix, Instructions (PDF) DMS English 10/2024 No
F-00163 Prior Authorization Drug Attachment for Weight Management Agents (Word) DMS English 07/2026 No
F-00163 Prior Authorization Drug Attachment for Weight Management Agents (PDF) DMS English 07/2026 No
F-00163A Prior Authorization Drug Attachment for Weight Management Agents Instructions (PDF) DMS English 07/2026 No
F-01176 Prior Authorization Fax Cover Sheet (PDF) DMS English 12/2025 No
F-01176 Prior Authorization Fax Cover Sheet (Word) DMS English 12/2025 No
F-11021 Prior Authorization Request / Hearing Instrument and Audiological Services (PDF) DMS English 07/2012 No
F-11021A Prior Authorization Request / Hearing Instrument and Audiological Services (PA/HIAS2) Completion Instructions (PDF) DMS English 11/2008 No
F-11021 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS2) (Word) DMS English 07/2012 No
F-11018 Prior Authorization Request Form (PA/RF) (PDF) DMS English 04/2026 No
F-11018 Prior Authorization Request Form (PA/RF) (Word) DMS English 04/2026 No
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) (PDF) DMS English 04/2017 No
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) (Word) DMS English 04/2017 No
F-11083A Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA): Completion Instructions (PDF) DMS English 04/2017 No
F-03432 Prior Authorization/Disposable Medical Supplies Attachment (PA/DMSA) (PDF) DMS English 08/2026 No
F-03432 Prior Authorization/Disposable Medical Supplies Attachment (PA/DMSA) (Word) DMS English 08/2026 No
F-11049 Prior Authorization/Drug Attachment (PA/DGA) (PDF) DMS English 01/2024 No
F-11049 Prior Authorization/Drug Attachment (PA/DGA) (Word) DMS English 01/2024 No
F-11049A Prior Authorization/Drug Attachment (PA/DGA), Instructions (PDF) DMS English 01/2024 No
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) (PDF) DMS English 06/2023 No
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) (Word) DMS English 06/2023 No
F-11054A Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA), Completion Instructions (PDF) DMS English 06/2023 No
F-00212 Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment (PDF) DMS English 02/2010 No
F-00212 Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment (Word) DMS English 02/2010 No
F-00212A Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment Instructions (PDF) DMS English 12/2019 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.

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Last revised September 30, 2025