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SeniorCare Forms

Below is a list of all SeniorCare 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-02340 Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement (PDF) DMS English 05/2023 No
F-02340AR Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Arabic (PDF) DMS Arabic 05/2023 No
F-02340CM Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Chinese (Simplified) (PDF) DMS Chinese (Simplified) 05/2023 No
F-02340G Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, German (PDF) DMS German 05/2023 No
F-02340H Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Hmong (PDF) DMS Hmong 05/2023 No
F-02340L Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Laotian (PDF) DMS Lao 05/2023 No
F-02340LP Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Large Print (PDF) DMS English 05/2023 No
F-02340R Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Russian (PDF) DMS Russian 05/2023 No
F-02340SO Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Somali (PDF) DMS Somali 05/2023 No
F-02340S Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare, Family Planning Only Services, SeniorCare, and Caretaker Supplement, Spanish (PDF) DMS Spanish 05/2023 No
F-10076 SeniorCare Application (PDF) DMS English 06/2026 Yes
F-10076A SeniorCare Application Instructions (PDF) DMS English 10/2025 Yes
F-10076ACM SeniorCare Application Instructions, Chinese (Simplified) (PDF) DMS Chinese (Simplified) 10/2025 No
F-10076AG SeniorCare Application Instructions, German (PDF) DMS German 10/2025 No
F-10076AH SeniorCare Application Instructions, Hmong (PDF) DMS Hmong 10/2025 No
F-10076AIT SeniorCare Application Instructions, Italian (PDF) DMS Italian 10/2025 No
F-10076AL SeniorCare Application Instructions, Laotian (PDF) DMS Lao 10/2025 No
F-10076AP SeniorCare Application Instructions, Polish (PDF) DMS Polish 10/2025 No
F-10076AR SeniorCare Application Instructions, Russian (PDF) DMS Russian 10/2025 No
F-10076AS SeniorCare Application Instructions, Spanish (PDF) DMS Spanish 10/2025 No
F-10076H SeniorCare Application, Hmong (PDF) DMS Hmong 06/2026 No
F-10076L SeniorCare Application, Laotian (PDF) DMS Lao 06/2026 No
F-10076S SeniorCare Application, Spanish (PDF) DMS Spanish 06/2026 No
F-13162 Wisconsin SeniorCare HIPAA Privacy Access Request (PDF) DMS English 07/2008 No
F-13163 Wisconsin SeniorCare HIPAA Privacy Accounting Request (PDF) DMS English 10/2008 No
F-13164 Wisconsin SeniorCare HIPAA Privacy Alternate Communication Request (PDF) DMS English 07/2008 No
F-13165 Wisconsin SeniorCare HIPAA Privacy Amendment Request (PDF) DMS English 07/2008 No
F-13161 Wisconsin SeniorCare HIPAA Privacy Authorization for Use or Disclosure (PDF) DMS English 07/2008 No
F-13166 Wisconsin SeniorCare HIPAA Privacy Complaint (PDF) DMS English 08/2018 No
F-13168 Wisconsin SeniorCare HIPAA Privacy Restriction Request (PDF) DMS English 07/2008 No
F-13167 Wisconsin SeniorCare HIPAA Privacy Revocation of Authorization (PDF) DMS English 07/2008 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