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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-11038A Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA): Completion Instructions DMS English 07/2012 PDF No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) DMS English 12/2019 PDF No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) DMS English 12/2019 Word No
F-01629A Prior Authorization / Behavioral Treatment Attachment (PA/BTA) Completion Instructions DMS English 12/2019 PDF No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) DMS English 07/2012 PDF No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) DMS English 07/2012 Word No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) DMS English 08/2015 PDF No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) DMS English 08/2015 Word No
F-11096A Prior Authorization / Care Plan Attachment (PA/CPA): Completion Instructions DMS English 09/2015 PDF No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) DMS English 12/2019 Word No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) DMS English 12/2019 PDF No
F-11040A Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) Instructions DMS English 12/2019 PDF No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 Word No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 PDF No
F-11029A Prior Authorization / Chiropractic Attachment (PA/CA) Completion Instructions DMS English 10/2008 PDF No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 Word No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 PDF No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 Word No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 PDF No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 Word No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 PDF No
F-00239A Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips Completion Instructions DMS English 07/2015 PDF No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 Word No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 PDF No
F-11030A Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) Instructions DMS English 02/2024 PDF No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) DMS English 07/2012 Word No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) DMS English 07/2012 PDF No
F-11088A Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA): Completion Instructions DMS English 07/2012 PDF No
F-11044 Prior Authorization / Home Health Therapy / Attachment (PA/HHTA) DMS English 07/2012 PDF No
F-11044 Prior Authorization / Home Health Therapy / Attachment (PA/HHTA) DMS English 07/2012 Word No
F-11044A Prior Authorization / Home Health Therapy / Attachment (PA/HHTA): Completion Instructions DMS English 07/2012 PDF No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) DMS English 12/2019 Word No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) DMS English 12/2019 PDF No
F-11036A Prior Authorization / In-Home Treatment Attachment (PA / ITA): Completion Instructions DMS English 12/2019 PDF No
F-03325 Prior Authorization / Intensive Outpatient Program (PA/IOP) DMS English 02/2025 PDF No
F-03325 Prior Authorization / Intensive Outpatient Program (PA/IOP) DMS English 02/2025 Word No
F-03325A Prior Authorization / Intensive Outpatient Program (PA/IOP) Instructions DMS English 02/2025 PDF No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) DMS English 07/2012 Word No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) DMS English 07/2012 PDF No
F-11033A Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) Completion Instructions DMS English 10/2008 PDF No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) DMS English 07/2012 PDF No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) DMS English 07/2012 Word No
F-11066A Prior Authorization / Oxygen Attachment (PA/OA): Completion Instructions DMS English 08/2015 PDF No
F-11016A Prior Authorization / Physician Attachment (PA/PA) Completion Instructions DMS English 07/2012 PDF No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) DMS English 07/2012 PDF No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) DMS English 07/2012 Word No
F-11019A Prior Authorization / Physician Otological Report (PA/POR) Completion Instructions DMS English 07/2012 PDF No
F-11305 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease DMS English 01/2016 PDF No
F-11305A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease: Completion Instructions DMS English 01/2016 PDF No
F-11307 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis DMS English 12/2012 PDF 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.

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Last revised December 4, 2024