Workers' comp, driver vision and medical evaluations, parking placard, Medicaid, sports physical and Game and Fish disability permit forms from Wyoming agencies.
Wyoming's clinician forms come from a handful of agencies. The Workers' Compensation Division of the Department of Workforce Services issues the Health Care Provider Initial Medical Report and the WCD-9 Application for Temporary Total Disability Benefits. WYDOT Driver Services handles the Driver Medical Evaluation, the Driver Vision Evaluation and the disabled parking placard application, and the WHSAA publishes the A-7/A-8 School Physical Examination Medical Record. This hub lists 15 forms, including Game and Fish disability permits.
On the WCD-9, the provider certifies an exam within the last 60 days. Surgery preauthorization is voluntary in Wyoming. WYDOT forms can be mailed, faxed, emailed or uploaded through oneWYO, and the placard application may trigger a driver license review. The WHSAA physician's statement must be dated after May 1 to count for the coming school year. Wyoming Medicaid is fee-for-service and uses a Documentation of Medical Necessity Form. Upload any fillable PDF to Vero Documents and it becomes a template the whole clinic can use.
Initial treating-provider report of history, examination findings, ICD-10 diagnosis, work-relatedness, treatment, impairment and release-to-work status for a Wyoming workers' compensation claim.
Injured worker's application for TTD benefits with the health care provider's certification of diagnosis, work-relatedness, restrictions, ascertainable loss and expected duration of total disability.
Written employer offer of light-duty or part-time work, with the health care provider certifying the offered work fits the employee's restrictions (W.S. 27-14-404(j)).
Documents chiropractic re-examination findings (complaints, range of motion, strength, PDQ scores) for a worker under active chiropractic care, or the discharge date.
Voluntary request by a surgeon for Division preauthorization of a surgery or procedure (diagnosis, CPT codes, work-relatedness, recovery estimate).
Requests preauthorization of DME over $2,500, listing items with HCPCS codes, with the treating provider's order or letter of medical necessity.
TTD application with provider certification used when TTD is sought beyond the normal limit under the extraordinary-circumstances provision.
FSDI-914Vision specialist reports acuity, fields (70 degrees per eye standard), progressive ocular conditions and an opinion on visual capability to drive, with restrictions.
FSDI-915Qualified medical professional states whether the driver is medically capable of driving (or a lapse-of-consciousness condition is controlled), with recommended restrictions, road test or annual re-evaluation (W.S. 31-7-123).
Licensed medical professional certifies the person is an 'eligible person' (W.S. 31-2-213) for a temporary (up to 6 months) or permanent placard; plates then come from the County Treasurer.
Physician/provider summarizes history, exam, labs and imaging to document the medical necessity of a prescribed service, including out-of-state services.
Medical history, physical examination and physician's statement required for WHSAA activities participation, with parent consent and emergency-care authorization.
Eye-care or physician certification of central visual acuity permanently 20/200 or worse (or 20-degree field) so the hunter may use a scope/aid and qualifies for a Disabled Hunter Permit.
Clinician certification that a hunter has a central visual acuity disability, upper-extremity disability, quadriplegia/paraplegia or 50% paralysis (or uses a wheelchair) for a hunting season extension permit.
Clinician certification that a hunter meets a Chapter 35 disability (mobility, lung, cardiac, cannot hold/shoot a firearm or bow, or 20/200 vision) for a Disabled Hunter Permit (incl. shooting from a vehicle).
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
An MD, DO or doctor of chiropractic. The A-7/A-8 signature line has no NP or PA option. The physician completes the physical examination and the physician's statement, which must be dated after May 1 to be valid for the upcoming school year. The form also carries the medical history, parent consent and emergency-care authorization, and it goes back to the school.
WYDOT Driver Services uses it to make the licensing decision. A qualified medical professional states whether the driver is medically capable of driving, or whether a lapse-of-consciousness condition is controlled, and can recommend restrictions, a road test or annual re-evaluation. Marking the driver not capable results in cancellation or denial. When the form is for an annual requirement, the exam must be within 3 months. Vision goes on the separate Driver Vision Evaluation.
A licensed medical doctor, nurse practitioner, physician assistant, optometrist or ophthalmologist. The clinician certifies a Chapter 35 disability, such as a mobility, lung or cardiac limitation, inability to hold or shoot a firearm or bow, or 20/200 vision, and marks it permanent or temporary. The physician portion can't be altered, and false statements by the clinician violate Commission Chapter 35. Disabled veterans may qualify without a clinician.
On the Documentation of Medical Necessity Form. The physician or other provider summarizes the history, exam, labs and imaging behind a prescribed service, including out-of-state services, then signs the attestation. Attach it to the prior authorization or claim with the Wyoming Medicaid Attachment Coversheet. Wyoming Medicaid is fee-for-service, and prior authorizations go through Acentra Health.