Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing from this site. If a form is not available electronically, you will be provided instructions for requesting a paper copy. If you are searching for a form number that does not start with the letter "F," just enter the number you have available and you will get a better search result. Example, looking for DDE-2539? Enter "2539" in the Search Forms field below.

The Division of Health Care Access and Accountability (DHCAA) and Division of Long Term Care (DLTC) have combined into the Division of Medicaid Services (DMS). When searching for forms by Division, please use the new acronym.

Assigned Numbersort ascending Title Division Other Location
F-00596 PPS Mental Health Module DCTS
F-00588a PPS AODA Deskcard DCTS
F-00588 PPS Alcohol and Other Drug Abuse Module DCTS
F-00580 Nursing Home Authorization for Access to Automated MDS 3.0 Section Q Referral Management System DMS
F-00577 Report Fraud OIG
F-00576A Tribal Aging and Disability Resource Specialist (TADRS) Annual Budget DPH
F-00576 Tribal Aging and Disability Resource Specialist (TADRS) Application DPH
F-00575 Notice of Intent to Submit an Application for Tribal Aging and Disability Resource Specialist (ADRS) DPH
F-00571 Emergency Mental Health Service Program Recertification Application - DHS 34 DQA
F-00569 Request for Waiver of Administrative Rule for Licensure DPH
F-00568 EMS Board Sub-Committee Appointment Application DPH
F-00567 Emergency Medical Services Complaint DPH
F-00565A County Performance Plan (CPP) Goals DMS
F-00565 County Performance Plan (CPP) DMS
F-00556 Prior Authorization Drug Attachment for Antipsychotic Drugs for Children 8 Years of Age and Younger DMS
F-00551 Emergency Mental Health Service Program Initial Certification Application - DHS 34 DQA
F-00548 Mental Health Day Treatment Services for Children Program Application - DHS 40 DQA
F-00547 Mental Health Inpatient Initial Certification Application - DHS 61.71 and 61.79 DQA
F-00546 Community Support Program (CSP) for Persons with Chronic Mental Illness Initial Certification Application - DHS 63 DQA
F-00545 Emergency Outpatient Service Initial Certification Application - DHS 75.05 DQA
F-00544 Community Substance Abuse Services (CSAS) Outpatient Treatment Service Initial Certification Application - DHS 75.13 DQA
F-00543A File Review Checklist DMS
F-00539 County Waiver Agency Support and Service Coordination (SSC) Rates DMS
F-00538 Community Substance Abuse Services (CSAS) Narcotic Treatment Service for Opiate Addiction Initial Certification Application - DHS 75.15 DQA
F-00537 Community Substance Abuse Services (CSAS) Intervention Services Initial Certification Application - DHS 75.16 DQA
F-00534 Partnership Member Requested Disenrollment or Transfer and Instructions DPH
F-00533 Partnership Programs - Enrollment DPH
F-00523 Community Substance Abuse Service (CSAS) General Requirements Initial Certification Application - DHS 75.03 DQA
F-00521 Community Substance Abuse Services (CSAS) Prevention Service Initial Certification Application - DHS 75.04 DQA
F-00520 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Initial Certification Application - DHS 75.06 DQA
F-00519 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Initial Certification Application - DHS 75.07 DQA
F-00518 Community Substance Abuse Services (CSAS) Ambulatory Detoxification Service Initial Certification Application - DHS 75.08 DQA
F-00517 Community Substance Abuse Services (CSAS) Residential Intoxification Monitoring Service Initial Certification Application - DHS 75.09 DQA
F-00516 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Treatment Service Initial Certification Application - DHS 75.10 DQA
F-00515 Community Substance Abuse Services (CSAS) Day Treatment Service Initial Certification Application - DHS 75.12 DQA
F-00514 Community Substance Abuse Services (CSAS) Medically Monitored Treatment Service Initial Certification Application - DHS 75.11 DQA
F-00513 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Initial Certification Application - DHS 75.14 DQA
F-00512 Mental Health Day Treatment Program Initial Certification Application - DHS 61.75 DQA
F-00482 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Initial Certification Application - Chapter DHS 36 DQA
F-00480 Child Outcomes Summary DMS
F-00479 Child Outcomes Fidelity Self-Assessment DMS
F-00476 CARES Automated Systems Access Request DMS
F-00475 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders: Recertification Application – DHS 36 DQA
F-00473 Community Substance Abuse Services (CSAS) Intervention Service Recertification Application - DHS 75.16 DQA
F-00472 Community Substance Abuse Services (CSAS) Narcotic Treatment Service for Opiate Addiction Recertification Application - DHS 75.15 DQA
F-00471 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Recertification Application - DHS 75.14 DQA
F-00470 Community Substance Abuse Services (CSAS) Day Treatment Service Recertification Application - DHS 75.12 DQA
F-00469 Community Substance Abuse Services (CSAS) Medically Monitored Treatment Service Recertification Application - DHS 75.11 DQA
F-00468 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Treatment Service Recertification Application - DHS 75.10 DQA
F-00467 Community Substance Abuse Services (CSAS) Residential Intoxification Monitoring Service Recertification Application - DHS 75.09 DQA

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Last Revised: March 26, 2019