2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form #3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Wis. Stat. § 450.076, the required renewal date for the Medical Oxygen Provider credential is 05/31/even years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
Effective May 1, 2015, all providers of home medical oxygen must be licensed by the Department (§450.076).
In order to obtain a Home Medical Oxygen Provider license, an applicant must be accredited by an approved organization (see the application below for a list of approved organizations).
Application for Licensure
3075||Application For Home Medical Oxygen Provider|
|3217||Application for Fee Reduction (This form must accompany the application for the credential)|
3085||Application for Predetermination|
2252||Convictions and Pending Charges|
3071||Fax Payment Form|