Worker's comp, retirement, DMV, parking, ForwardHealth prior authorization, W-2, child care, sports, WIC and DNR forms from Wisconsin agencies, with who completes each.
Wisconsin's clinician forms come from WisDOT's Division of Motor Vehicles, ForwardHealth (Wisconsin Medicaid), the Department of Children and Families (DCF), the WIAA and the Worker's Compensation Division. The ones practices see most are the WIAA Student-Athlete Physical Card, the ForwardHealth Prior Authorization Request Form (PA/RF, F-11018) with its attachments, the MV2548 and MV2933 disabled parking permit applications and the DCF Child Health Report for child care centers. This hub lists 41 forms.
Most ForwardHealth fee-for-service requests pair the PA/RF with a service attachment, such as the PA/DMEA for equipment or the PA/DGA for drugs. WisDOT medical review forms such as the MV3644 and MV3030V need an exam within 90 days. WRS disability retirement takes two physician reports on the ET-5303, which ETF mails to the member instead of posting online. W-2 medical forms like the DWSP2012 go back to the W-2 agency. 9 forms here have a Spanish version, including the parking permit applications.
Certified medical opinion on causation, disability and permanency used as evidence at a worker's compensation hearing instead of live testimony.
Treating practitioner's report of diagnosis, treatment, temporary disability period and permanent disability rating for a claim with more than 3 weeks of disability or permanent disability.
Physician's report of visual acuity and field loss for determining permanent disability from an eye injury under DWD 80.26.
ET-5303Licensed physician certifies that a Wisconsin Retirement System participant meets the statutory definition of disabled for a WRS disability retirement benefit (Wis. Stat. 40.63).
Physician's report establishing a state employee's disability for Income Continuation Insurance benefits under Wis. Stat. 40.61 and 40.62.
Physician recertifies that a WRS disability retirement annuitant remains disabled, based on an examination within the past 12 months.
Vision examiner reports acuity, fields, color and progressive eye conditions when WisDOT requires a vision report for licensing.
Health care professional reports a driver's medical conditions and gives an opinion on whether the person is medically safe to drive, for WisDOT Medical Review.
Physical examination required before WisDOT licenses a driver for a school bus (S) or passenger (P) endorsement under Trans 112.
Substance use counselor reports dependency assessment, treatment recommendations and compliance for a driver under WisDOT medical review for alcohol or drug use.
Permiso de Estacionamiento para Personas con Discapacidad Permanente Información y Solicitud
Health care specialist certifies a permanent disability for a Wisconsin disabled parking identification (DIS ID) permit.
Permiso de Estacionamiento para Personas con Discapacidad Temporal Información y Solicitud
Health care specialist certifies a temporary disability for a temporary Wisconsin DIS ID parking permit.
Licensed healthcare professional's verification supporting a Transit Plus ADA paratransit application in Milwaukee County.
Placas de Estacionamiento para Personas con Discapacidad Información y Solicitud
Health care specialist certifies a permanent disability for disabled parking license plates (s. 341.14(1a)); optionally adds a DIS ID permit.
Treating provider certification that a rider's permanent or temporary impairment meets MCTS reduced-fare disability criteria, for a Reduced Fare ID card.
Cover request form required with most Wisconsin Medicaid/BadgerCare Plus fee-for-service prior authorization requests (with a service-specific attachment).
Prescriber and DME provider document medical necessity for durable medical equipment needing prior authorization.
F-01068A to F-01068LAge-specific HealthCheck (EPSDT) well-child visit documentation templates from the 3-4 week visit through the teenager visit.
Medical care provider certifies a member's need for specialized medical vehicle (wheelchair van) transportation.
General prior authorization attachment for drugs that need PA where no drug-specific form exists.
Prescriber documents diagnosis, growth/nutrition status and medical need for enteral nutrition formula needing prior authorization.
Requests coverage of a non-preferred drug on the Wisconsin Medicaid Preferred Drug List.
Physician's otological examination report supporting prior authorization of hearing instruments for a Wisconsin Medicaid member.
Documents the plan and medical need for home health physical, occupational or speech therapy needing prior authorization.
Prescriber documents qualifying oxygen testing and medical need for home oxygen needing prior authorization.
DCF-F-CFS0060-EInforme de Salud Infantil - Centros de Cuidado Infantil
Health examination report required for children enrolling in Wisconsin licensed child care centers (DCF 251), repeated per age schedule.
DCF-F-CFS0054Health examination report showing a child care center staff member is physically able to care for children (DCF 251.05).
Biennial preparticipation history, physical exam and medical eligibility; only the Medical Eligibility Form (p. 4) goes to the school.
Physician release documenting diagnosis, treatment and contagious status so a wrestler with a skin lesion may compete.
F-04020LWisconsin school immunization record (Wis. Stat. 252.04, 120.12(16)) returned within 30 school days of admission; includes a clinician attestation of reliable varicella history and lab immunity, and references health/religious/personal conviction waivers.
Combined WIC referral (height, weight, hemoglobin) and request for medical formula/food for an infant or child with a qualifying condition.
Medical statement supporting a meal modification (disability-related diet, allergy, texture or substitution) in the USDA school meal programs (NSLP/SBP), as required by 7 CFR 210.10(m) and Section 504/ADA.
Combined WIC referral and request for medical formula/food for a pregnant, breastfeeding or postpartum patient.
Emergency Care Do Not Resuscitate Order (DNR), Spanish
Out-of-hospital DNR order that, with a Wisconsin DNR bracelet, directs EMS not to resuscitate (Wis. Stat. ch. 154).
Provider report of a Category I, II or III reportable communicable disease or condition to the local public health department.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Every other year. The WIAA requires a physical exam every second year, with a parent-signed alternate-year card in between. The examining physician, PA, NP or chiropractor completes the physical examination on page 3 and the Medical Eligibility Form on page 4 of the Student-Athlete Physical Card, which follows the PPE 5th edition. Only page 4 goes to the school; the rest stays with the provider or family. A Spanish version is available.
A physician, podiatrist, advanced practice nurse, chiropractor, public health nurse, physician assistant or physical therapist licensed in any state, or a Christian Science practitioner residing in Wisconsin. Use the MV2548 for a permanent permit and the MV2933 for a temporary one; disabled parking plates use the MV2162. The clinician completes the certification section, and the patient files it with WisDOT. All three have Spanish versions.
The Prior Authorization Request Form (F-11018), the cover form required with most Wisconsin Medicaid and BadgerCare Plus fee-for-service prior authorization requests. The requesting provider fills in provider, member, diagnosis and service details and signs. It goes with a service-specific attachment, such as the PA/DMEA (F-11030), PA/ENFA (F-11054) or PA/OA (F-11066), through the ForwardHealth Portal, by fax or by mail. HMO members go through the HMO's own process.
Two licensed physicians (MD or DO), one of them specializing in the area of the disability, each complete an ET-5303 after the member fills in their portion. ETF does not post the form online; it mails it in the disability packet. Physicians return it directly to ETF in the envelopes provided, and ETF must receive both reports and the employer certification within 12 months of the application. Annual recertification uses the ET-5909.