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Medicaid Forms

Below is a list of all Medicaid 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 File type Available to order
F-01270 Comprehensive Community Services Non-Traditional Approval DMS English 07/2014 PDF No
F-01270 Comprehensive Community Services Non-Traditional Approval DMS English 07/2014 Word No
F-01068M Confidential Health Survey DMS English 08/2019 PDF No
F-01068M Confidential Health Survey DMS English 08/2019 Word No
F-01068MS Confidential Health Survey, Spanish DMS Spanish 08/2019 PDF No
F-01068MS Confidential Health Survey, Spanish DMS Spanish 08/2019 Word No
N/A Consent for Sterilization DMS English 06/2025 PDF No
N/A Consent for Sterilization Form, Instructions DMS English 06/2025 PDF No
N/A Consent for Sterilization Form, Spanish DMS Spanish 06/2025 PDF No
F-16104 Customer Experience Survey DMS English 12/2025 PDF Yes
F-16104A Customer Experience Survey DMS English, Hmong, Spanish 12/2025 HTML No
F-16104H Customer Experience Survey, Hmong DMS Hmong 12/2025 PDF No
F-16104S Customer Experience Survey, Spanish DMS Spanish 10/2017 PDF No
F-01182 Declaration of Supervision for Nonbilling Providers DMS English 06/2025 PDF No
F-01182 Declaration of Supervision for Nonbilling Providers DMS English 06/2025 Word No
F-03203 Disenrollment of Adult Long-Term Care (LTC) Waiver Program and Services DMS English 09/2024 Word No
F-10193 Divestment Penalty and Undue Hardship Notice Plus Waiver Request DMS English 08/2021 PDF No
F-10193S Divestment Penalty and Undue Hardship Notice Plus Waiver Request, Spanish DMS Spanish 08/2021 PDF No
F-00020 Drug Addition Review Request DMS English 02/2025 PDF No
F-00020 Drug Addition Review Request DMS English 02/2025 Word No
F-11304 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis DMS English 01/2025 Word No
F-11304 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ankylosing Spondylitis DMS English 01/2025 PDF No
F-01950 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease and Ulcerative Colitis DMS English 01/2025 PDF No
F-01950 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease and Ulcerative Colitis DMS English 01/2025 Word No
F-01952 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis DMS English 01/2025 PDF No
F-01952 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis DMS English 01/2025 Word No
F-01952A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis Instructions DMS English 01/2025 PDF No
F-11304A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Ankylosing Spondylitis Instructions DMS English 01/2025 PDF No
F-01950A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Crohn’s Disease and Ulcerative Colitis Instructions DMS English 01/2025 PDF No
F-03174 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Hidradenitis Suppurativa DMS English 01/2025 PDF No
F-03174 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Hidradenitis Suppurativa DMS English 01/2025 Word No
F-03174A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Hidradenitis Suppurativa Instructions DMS English 01/2025 PDF No
F-11306 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Psoriasis DMS English 01/2025 PDF No
F-11306 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Psoriasis DMS English 01/2025 Word No
F-11306A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Psoriasis Instructions DMS English 01/2025 PDF No
F-01951 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis DMS English 01/2025 Word No
F-01951 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis DMS English 01/2025 PDF No
F-01951A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis Instructions DMS English 01/2025 PDF No
F-03224 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Uveitis DMS English 01/2025 PDF No
F-03224 Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Uveitis DMS English 01/2025 Word No
F-03224A Effective for use before 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Uveitis Instructions DMS English 01/2025 PDF No
F-00079 Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil DMS English 01/2019 PDF No
F-00079A Effective for use before 07/01/2019: Prior Authorization/Preferred Drug List (PA/PDL) for Armodafinil and Modafinil Instructions DMS English 01/2019 PDF No
F-01952 Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis (nr-axSpA) DMS English 12/2025 Word No
F-01952 Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis (nr-axSpA) DMS English 12/2025 PDF No
F-01952A Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Giant Cell Arteritis and Non-Radiographic Axial Spondyloarthritis (nr-axSpA) Instructions DMS English 12/2025 PDF No
F-03224 Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Oral Ulcers Associated With Behcet’s Disease and Uveitis DMS English 12/2025 Word No
F-03224 Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Oral Ulcers Associated With Behcet’s Disease and Uveitis DMS English 12/2025 PDF No
F-03224A Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Oral Ulcers Associated With Behcet’s Disease and Uveitis Instructions DMS English 12/2025 PDF No
F-11304 Effective for use on and after 01/01/2026: Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) for Ankylosing Spondylitis DMS English 12/2025 Word 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