Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Numbersort descending Title Division Other Location
F-00473 Community Substance Abuse Services (CSAS) Intervention Service Recertification Application - DHS 75.16 DQA
F-00475 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders: Recertification Application – DHS 36 DQA
F-00476 CARES Automated Systems Access Request DMS
F-00479 Child Outcomes Fidelity Self-Assessment DMS
F-00480 Child Outcomes Summary DMS
F-00482 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Initial Certification Application - Chapter DHS 36 DQA
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA
F-00513 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Initial Certification Application - DHS 75.14 DQA
F-00514 Community Substance Abuse Services (CSAS) Medically Monitored Treatment Service Initial Certification Application - DHS 75.11 DQA
F-00515 Community Substance Abuse Services (CSAS) Day Treatment Service Initial Certification Application - DHS 75.12 DQA
F-00516 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Treatment Service Initial Certification Application - DHS 75.10 DQA
F-00517 Community Substance Abuse Services (CSAS) Residential Intoxification Monitoring Service Initial Certification Application - DHS 75.09 DQA
F-00518 Community Substance Abuse Services (CSAS) Ambulatory Detoxification Service Initial Certification Application - DHS 75.08 DQA
F-00519 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Initial Certification Application - DHS 75.07 DQA
F-00520 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Initial Certification Application - DHS 75.06 DQA
F-00521 Community Substance Abuse Services (CSAS) Prevention Service Initial Certification Application - DHS 75.04 DQA
F-00523 Community Substance Abuse Service (CSAS) General Requirements Initial Certification Application - DHS 75.03 DQA
F-00533 Partnership Programs — Enrollment DPH
F-00534 Partnership Member Requested Disenrollment or Transfer and Instructions DPH
F-00537 Community Substance Abuse Services (CSAS) Intervention Services Initial Certification Application - DHS 75.16 DQA
F-00538 Community Substance Abuse Services (CSAS) Narcotic Treatment Service for Opiate Addiction Initial Certification Application - DHS 75.15 DQA
F-00539 County Waiver Agency Support and Service Coordination (SSC) Rates DMS
F-00543A File Review Checklist DMS
F-00544 Community Substance Abuse Services (CSAS) Outpatient Treatment Service Initial Certification Application - DHS 75.13 DQA
F-00545 Emergency Outpatient Service Initial Certification Application - DHS 75.05 DQA
F-00546 Community Support Program (CSP) for Persons with Chronic Mental Illness Initial Certification Application - DHS 63 DQA
F-00547 Mental Health Inpatient Initial Certification Application - DHS 61.71 and 61.79 DQA
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA
F-00551 Emergency Mental Health Service Program Initial Certification Application - DHS 34 DQA
F-00556 Prior Authorization Drug Attachment for Antipsychotic Drugs for Children 8 Years of Age and Younger DMS
F-00565 County Performance Plan (CPP) DMS
F-00565A County Performance Plan (CPP) Goals DMS
F-00567 Emergency Medical Services Complaint DPH
F-00568 EMS Board Sub-Committee Appointment Application DPH
F-00569 Request for Waiver of Administrative Rule for Licensure DPH
F-00571 Emergency Mental Health Service Program Recertification Application - DHS 34 DQA
F-00575 Notice of Intent to Submit an Application for Tribal Aging and Disability Resource Specialist (ADRS) DPH
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH
F-00577 Report Fraud OIG
F-00580 Nursing Home Authorization for Access to Automated MDS 3.0 Section Q Referral Management System DMS
F-00588 PPS Alcohol and Other Drug Abuse Module DCTS
F-00588a PPS AODA Deskcard DCTS
F-00596 PPS Mental Health Module DCTS
F-00596a PPS Mental Health Deskcard DCTS
F-00603 PPS (Program Participation System) Core Module DES
F-00603a PPS Core Deskcard DES
F-00607 Complaint Intake Survey DQA
F-00614 Physician, Physician Assistant, and Registered Nurse Equivalency Application DPH
F-00615 Change Project Report and Instructions DPH

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Last Revised: March 23, 2021