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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-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
F-11307A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis: Completion Instructions DMS English 07/2015 PDF No
F-11308 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis DMS English 12/2012 PDF No
F-11308A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis: Completion Instructions DMS English 07/2015 PDF No
F-00694A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ulcerative Colitis Completion Instructions DMS English 07/2015 PDF No
F-00622 Prior Authorization / Preferred Drug List (PA/PDL) for Migraine Agents, Injectable DMS English 06/2012 PDF No
F-00280 Prior Authorization / Preferred Drug List (PA/PDL) for Migraine Agents, Other DMS English 07/2013 PDF No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents DMS English 09/2019 Word No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents DMS English 09/2019 PDF No
F-11097A Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents: Completion Instructions DMS English 07/2015 PDF No
F-00080 Prior Authorization / Preferred Drug List (PA/PDL) for Symlin DMS English 10/2011 PDF No
F-00080A Prior Authorization / Preferred Drug List (PA/PDL) for Symlin Completion Instructions DMS English 07/2015 PDF No
F-11031 Prior Authorization / Psychotherapy Attachment (PA/PSYA) DMS English 07/2012 PDF No
F-11031 Prior Authorization / Psychotherapy Attachment (PA/PSYA) DMS English 07/2012 Word No
F-11031A Prior Authorization / Psychotherapy Attachment (PA/PSYA) Completion Instructions DMS English 10/2008 PDF No
F-02567 Prior Authorization / Residential Substance Use Disorder Treatment Attachment (PA/RSUD) DMS English 02/2023 PDF No
F-02567 Prior Authorization / Residential Substance Use Disorder Treatment Attachment (PA/RSUD) DMS English 02/2023 Word No
F-02567A Prior Authorization / Residential Substance Use Disorder Treatment Attachment (PA/RSUD), Instructions DMS English 02/2023 PDF No
F-11039 Prior Authorization / Spell of Illness Attachment (PA/SOIA) DMS English 10/2015 Word No
F-11039 Prior Authorization / Spell of Illness Attachment (PA/SOIA) DMS English 10/2015 PDF No
F-11039A Prior Authorization / Spell of Illness Attachment (PA/SOIA): Completion Instructions DMS English 10/2015 PDF No
F-11032 Prior Authorization / Substance Abuse Attachment (PA/SAA) DMS English 07/2012 Word No
F-11032 Prior Authorization / Substance Abuse Attachment (PA/SAA) DMS English 07/2012 PDF No
F-11032A Prior Authorization / Substance Abuse Attachment (PA/SAA) Completion Instructions DMS English 10/2008 PDF No
F-11037 Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA) DMS English 07/2012 PDF No
F-11037 Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA) DMS English 07/2012 Word No
F-11037A Prior Authorization / Substance Abuse Day Treatment Attachment (PA/SADTA): Completion Instructions DMS English 07/2012 PDF No
F-11008 Prior Authorization / Therapy Attachment (PA/TA) DMS English 07/2024 PDF No
F-11008 Prior Authorization / Therapy Attachment (PA/TA) DMS English 07/2024 Word No
F-11051 Prior Authorization / Vision Services Attachment (PA/VA) DMS English 10/2020 Word No
F-11051 Prior Authorization / Vision Services Attachment (PA/VA) DMS English 10/2020 PDF No
F-11051A Prior Authorization / Vision Services Attachment (PA/VA), Instructions DMS English 10/2020 PDF No
F-11042 Prior Authorization Amendment Request DMS English 07/2012 Word No
F-11042 Prior Authorization Amendment Request DMS English 07/2012 PDF No
F-11042A Prior Authorization Amendment Request Completion Instructions DMS English 07/2012 PDF No
F-11035 Prior Authorization Dental Request Form (PA/DRF) DMS English 06/2024 PDF No
F-11035 Prior Authorization Dental Request Form (PA/DRF) DMS English 06/2024 Word No
F-11035A Prior Authorization Dental Request Form (PA/DRF) Instructions DMS English 06/2024 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