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Official DHS Forms Library

Forms produced by the Wisconsin Department of Health Services are available electronically and/or for paper order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions. When you are searching for a document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks (" ") around search terms.

If you are looking for an informative document, visit our Informative Documents and Publications Library. If you need a file in another file format or can't find what you are looking for here, reach out to the Digital Communications Team at dhsfmorder@dhs.wisconsin.gov. You can typically expect a response within 1-2 business days.

Assigned Number Title Division Language Release Date File Type Available to Order
F-01674 Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa DMS English 01/2017 PDF No
F-01674 Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa DMS English 01/2017 Word No
F-01674A Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa Completion Instructions DMS English 01/2017 PDF No
F-02433 Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex DMS English 04/2021 Word No
F-02433 Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex DMS English 04/2021 PDF No
F-02433A Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex, Instructions DMS English 04/2021 PDF No
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs DMS English 07/2024 PDF No
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs DMS English 07/2024 Word No
F-11092A Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs Instructions DMS English 07/2024 PDF No
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable DMS English 07/2020 Word No
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable DMS English 07/2020 PDF No
F-02668A Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable Instructions DMS English 07/2020 PDF No
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical DMS English 01/2025 Word No
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical DMS English 01/2025 PDF No
F-02572A Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical Instructions DMS English 01/2025 PDF No
F-03370 Prior Authorization/Preferred Drug List (PA/PDL) for Journavx DMS English 05/2025 Word No
F-03370 Prior Authorization/Preferred Drug List (PA/PDL) for Journavx DMS English 05/2025 PDF No
F-03370A Prior Authorization/Preferred Drug List (PA/PDL) for Journavx Instructions DMS English 05/2025 PDF No
F-00622A Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Injectable Completion Instructions DMS English 07/2015 PDF No
F-00280A Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Other Completion Instructions DMS English 07/2015 PDF No
F-00079A Prior Authorization/Preferred Drug List (PA/PDL) for Modafinil and Nuvigil Completion Instructions DMS English 01/2017 PDF No
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants DMS English 01/2017 PDF No
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants DMS English 01/2017 Word No
F-01672A Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants, Instructions DMS English 01/2022 PDF No
F-11077 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) DMS English 01/2018 PDF No
F-11077 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) DMS English 01/2018 Word No
F-11077A Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Instructions DMS English 01/2022 PDF No
F-00081 Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents—Buprenorphine DMS English 07/2024 Word No
F-00081 Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents—Buprenorphine DMS English 07/2024 PDF No
F-00081A Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents—Buprenorphine Instructions DMS English 07/2024 PDF No
F-01673 Prior Authorization/Preferred Drug List (PA/PDL) for Orexin Receptor Antagonists DMS English 04/2022 PDF No
F-01673 Prior Authorization/Preferred Drug List (PA/PDL) for Orexin Receptor Antagonists DMS English 04/2022 Word No
F-01673A Prior Authorization/Preferred Drug List (PA/PDL) for Orexin Receptor Antagonists, Instructions DMS English 04/2022 PDF No
F-11078 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Capsules, Suspensions, and Non-Orally Disintegrating Tablets DMS English 07/2022 PDF No
F-11078 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Capsules, Suspensions, and Non-Orally Disintegrating Tablets DMS English 07/2022 Word No
F-11078A Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Capsules, Suspensions, and Non-Orally Disintegrating Tablets Instructions DMS English 07/2022 PDF No
F-00433 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets DMS English 07/2022 PDF No
F-00433 Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets DMS English 07/2022 Word No
F-00433A Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets Instructions DMS English 07/2022 PDF No
F-00315C Prior Notice and Consent for Evaluation and Assessment DMS English 03/2025 PDF No
F-00315CS Prior Notice and Consent for Evaluation and Assessment, Spanish DMS Spanish 03/2025 PDF No
F-11252 Private Duty Nursing for Members for Ventilator-Dependent Life-Support Addendum DMS English 05/2019 Word No
F-11252 Private Duty Nursing for Members for Ventilator-Dependent Life-Support Addendum DMS English 05/2019 PDF No
F-11041 Private Duty Nursing Prior Authorization Acknowledgment DMS English 10/2008 Word No
F-11041 Private Duty Nursing Prior Authorization Acknowledgment DMS English 10/2008 PDF No
F-13033 Probate Claims Notice DMS English 05/2021 PDF No
F-21150A Procedure for Seeking an Independent Investigation due to Conflict of Interest with APS Reports DPH English 04/2025 PDF No
F-80881 Profile ID Request (CARS) and Instructions DES English 11/2022 Excel No
F-02167 Program Participation System (PPS) PORTAL Report Feedback DCTS English 07/2017 Word No
F-21225A Program Participation System (PPS): B-3 Module DMS English 04/2023 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 December 4, 2024