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 Number Titlesort descending Division Other Location
F-00515 Community Substance Abuse Services (CSAS) Day Treatment Service Initial Certification Application - DHS 75.12 DQA
F-00470 Community Substance Abuse Services (CSAS) Day Treatment Service Recertification Application - DHS 75.12 DQA
F-00439 Community Substance Abuse Services (CSAS) Emergency Outpatient Service Recertification Application - DHS 75.05 DQA
F-00473 Community Substance Abuse Services (CSAS) Intervention Service Recertification Application - DHS 75.16 DQA
F-00537 Community Substance Abuse Services (CSAS) Intervention Services Initial Certification Application - DHS 75.16 DQA
F-00520 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Initial Certification Application - DHS 75.06 DQA
F-00464 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Detoxification Service Recertification Application - DHS 75.06 DQA
F-00516 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Treatment Service Initial Certification Application - DHS 75.10 DQA
F-00468 Community Substance Abuse Services (CSAS) Medically Managed Inpatient Treatment Service Recertification Application - DHS 75.10 DQA
F-00519 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Initial Certification Application - DHS 75.07 DQA
F-00465 Community Substance Abuse Services (CSAS) Medically Managed Residential Detoxification Service Recertification Application - DHS 75.07 DQA
F-00514 Community Substance Abuse Services (CSAS) Medically Monitored Treatment Service Initial Certification Application - DHS 75.11 DQA
F-00469 Community Substance Abuse Services (CSAS) Medically Monitored Treatment Service Recertification Application - DHS 75.11 DQA
F-00538 Community Substance Abuse Services (CSAS) Narcotic Treatment Service for Opiate Addiction Initial Certification Application - DHS 75.15 DQA
F-00472 Community Substance Abuse Services (CSAS) Narcotic Treatment Service for Opiate Addiction Recertification Application - DHS 75.15 DQA
F-00302 Community Substance Abuse Services (CSAS) Outpatient Clinic Recertification Application - DHS 75.13 Outpatient Treatment Service DQA
F-00544 Community Substance Abuse Services (CSAS) Outpatient Treatment Service Initial Certification Application - DHS 75.13 DQA
F-00521 Community Substance Abuse Services (CSAS) Prevention Service Initial Certification Application - DHS 75.04 DQA
F-00517 Community Substance Abuse Services (CSAS) Residential Intoxification Monitoring Service Initial Certification Application - DHS 75.09 DQA
F-00467 Community Substance Abuse Services (CSAS) Residential Intoxification Monitoring Service Recertification Application - DHS 75.09 DQA
F-00513 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Initial Certification Application - DHS 75.14 DQA
F-00471 Community Substance Abuse Services (CSAS) Transitional Residential Treatment Service Recertification Application - DHS 75.14 DQA
F-00438 Community Substance Abuse Services (CSAS) Verification of Criteria - DHS 75.02 (11) DQA
F-00546 Community Support Program (CSP) for Persons with Chronic Mental Illness Initial Certification Application - DHS 63 DQA
F-02704 Community Testing Support Program Application CRT
F-10097A Community-Based Long-Term Care Services Medicaid Income Allocation DMS
F-02634B Community-Based Residential Facility (CBRF) Initial Survey Checklist DQA
F-02778 Community-Based Vaccination Clinic Request for Dedicated Vaccine Supply
F-00607 Complaint Intake Survey DQA
F-20009 Complaint Report DCTS
F-62495 Compliance Statement DQA
F-13073 Compound Drug Claim DMS
F-00482 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Initial Certification Application - Chapter DHS 36 DQA
F-01216 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders Regional Model Supplemental Application DHS 36 DQA
F-00475 Comprehensive Community Services (CCS) for Persons with Mental Disorders and Substance Use Disorders: Recertification Application – DHS 36 DQA
F-02124 Comprehensive Community Services (CCS) Program Survey Worksheet DCTS
F-02759 Comprehensive Community Services Cost Settlement Advance Request DMS
F-01270 Comprehensive Community Services Non-Traditional Approval DMS
F-25614 Conditional Release Rules and Conditions DCTS
F-40054 Confidential Birth Defects Registry Report DPH
F-40054A Confidential Birth Defects Registry – Request to Remove Identifiers DPH
F-01068M Confidential Health Survey DMS
F-82009 Confidential Information Release Authorization - Generic  DES
F-82009AA Confidential Information Release Authorization - Katie Beckett Program DMS
F-82009Y Confidential Information Release Authorization - Testing Records DCTS
F-82009TC Confidential Information Release Authorization for Transportation Complaint Research DMS
F-82009V Confidential Information Release Authorization: Rehabilitation Review OLC
F-82009W Confidential Information Release Authorization: Two Entities OLC
F-82009F Confidential Information Release Authorization: WISHIN DCTS
F-02829 Confidentiality Agreement For Receipt of CMS Unique ID – SHIP DPH

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Last Revised: March 23, 2021