The Division of Mental Health and Substance Abuse Services has created a form (F-00260 (Word, 125 KB)) to document it's quality review of CRS Individual Service Plan (ISP) packets submitted by counties or tribes. This form serves as evidence of the state's review of each service plan packet. This form may also be used as a resource for county and tribal agency staff as they prepare service plan packets for submittal.
Counties are encouraged to use the following ISP template but are not required to do so. If counties choose to use their own template, the domains listed in form F-00202 should be included in the county document.
- Individual Service Plan, F-00202 (Word, 117 KB)
- Individual Service Plan Instructions, F-00202i (PDF, 177 KB)
Submission of service plan packets must include the following:
- Substitute Care Room and Board Rate Calculation Spreadsheet (Excel, 41 KB)
- Formula to Determine Amount of Income Available to Pay for Room and Board In Substitute Care, F-20920 (Excel, 42 KB)
Note: When downloading a form, you may get a Windows Security popup box asking for a login ID and a password. The form will open if you choose "Cancel".
Questions regarding the form content or preparation of CRS Individual Service Plan packets should be addressed to:
CRS Quality Service Specialist
Wisconsin Department of Health Services
Division of Mental Health and Substance Abuse Services
1 West Wilson Street, Room 851
Madison, WI 53703
Note: The Community Recovery Services Service Plan Packet Quality Review Results Form (F-00260) (Word, 125 KB) is provided as courtesy only to assist counties and tribes as they prepare their consumer applications. Please do not submit this form as part of your consumer application.