Skip to main content

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-02505 Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors DMS English 07/2024 Word No
F-02505A Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors Instructions DMS English 07/2024 PDF No
F-02371 Prior Authorization Drug Attachment for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists DMS English 07/2019 PDF No
F-02371A Prior Authorization Drug Attachment for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists Instructions DMS English 07/2019 PDF No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil DMS English 01/2018 PDF No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil DMS English 07/2018 PDF No
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions DMS English 01/2018 PDF No
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions DMS English 07/2018 PDF No
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® DMS English 01/2017 PDF No
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents DMS English 07/2023 PDF No
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents DMS English 07/2023 Word No
F-00805A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Instructions DMS English 07/2023 PDF No
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons DMS English 07/2023 Word No
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons DMS English 07/2023 PDF No
F-03175A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons Instructions DMS English 07/2023 PDF No
F-02537 Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting DMS English 11/2019 PDF No
F-02537 Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting DMS English 11/2019 Word No
F-02537A Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting, Instructions DMS English 11/2019 PDF No
F-02573 Prior Authorization Drug Attachment for Wakix DMS English 10/2024 PDF No
F-02573 Prior Authorization Drug Attachment for Wakix DMS English 10/2024 Word No
F-02573A Prior Authorization Drug Attachment for Wakix, Instructions DMS English 10/2024 PDF No
F-01430 Prior Authorization Drug Attachment for Xyrem and Xywav DMS English 12/2021 PDF No
F-01430 Prior Authorization Drug Attachment for Xyrem and Xywav DMS English 12/2021 Word No
F-01430A Prior Authorization Drug Attachment for Xyrem and Xywav, Instructions DMS English 12/2021 PDF No
F-01176 Prior Authorization Fax Cover Sheet DMS English 09/2022 Word No
F-01176 Prior Authorization Fax Cover Sheet DMS English 09/2022 PDF No
F-02815 Prior Authorization for Hospital Prolonged Stay DMS English 04/2022 Word No
F-02815 Prior Authorization for Hospital Prolonged Stay DMS English 04/2022 PDF No
F-02815 Prior Authorization for Hospital Prolonged Stay Fax Cover Sheet DMS English 01/2022 Word No
F-02815A Prior Authorization for Hospital Prolonged Stay Fax Cover Sheet DMS English 01/2022 PDF No
F-11016 Prior Authorization Physician Attachment (PA/PA) DMS English 07/2012 Word No
F-11016 Prior Authorization Physician Attachment (PA/PA) DMS English 07/2012 PDF No
F-11021 Prior Authorization Request / Hearing Instrument and Audiological Services DMS English 07/2012 PDF No
F-11021A Prior Authorization Request / Hearing Instrument and Audiological Services (PA/HIAS2) Completion Instructions DMS English 11/2008 PDF No
F-11020 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) DMS English 05/2013 PDF No
F-11020 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) DMS English 05/2013 Word No
F-11020A Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) Completion Instructions DMS English 02/2016 PDF No
F-11021 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS2) DMS English 07/2012 Word No
F-11018 Prior Authorization Request Form (PA/RF) DMS English 05/2013 PDF No
F-11018 Prior Authorization Request Form (PA/RF) DMS English 05/2013 Word No
F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (CT), Magnetic Resonance (MR), and Magnetic Resonance Elastography (MRE) Imaging Services DMS English 02/2019 Word No
F-00787 Prior Authorization Requirements Exemption Request for Computed Tomography (CT), Magnetic Resonance (MR), and Magnetic Resonance Elastography (MRE) Imaging Services DMS English 02/2019 PDF No
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) DMS English 04/2017 PDF No
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) DMS English 04/2017 Word No
F-11083A Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA): Completion Instructions DMS English 04/2017 PDF No
F-11049 Prior Authorization/Drug Attachment (PA/DGA) DMS English 01/2024 PDF No
F-11049 Prior Authorization/Drug Attachment (PA/DGA) DMS English 01/2024 Word No
F-11049A Prior Authorization/Drug Attachment (PA/DGA), Instructions DMS English 01/2024 PDF No
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) DMS English 06/2023 Word No
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) DMS English 06/2023 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.

Glossary

 
Last revised December 4, 2024