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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-02774 Prenatal Care Coordination Postpartum Assessment Tool DPH English 05/2021 Word No
F-01105 Prenatal Care Coordination Pregnancy Questionnaire DMS English 07/2024 Word No
F-01105 Prenatal Care Coordination Pregnancy Questionnaire DMS English 07/2024 PDF No
F-01105A Prenatal Care Coordination Pregnancy Questionnaire Instructions DMS English 07/2024 PDF No
F-01105AH Prenatal Care Coordination Pregnancy Questionnaire Instructions, Hmong DMS Hmong 07/2024 PDF No
F-01105AS Prenatal Care Coordination Pregnancy Questionnaire Instructions, Spanish DMS Spanish 07/2024 PDF No
F-01105H Prenatal Care Coordination Pregnancy Questionnaire, Hmong DMS Hmong 07/2024 Word No
F-01105H Prenatal Care Coordination Pregnancy Questionnaire, Hmong DMS Hmong 07/2024 PDF No
F-01105S Prenatal Care Coordination Pregnancy Questionnaire, Spanish DMS Spanish 07/2024 Word No
F-01105S Prenatal Care Coordination Pregnancy Questionnaire, Spanish DMS Spanish 07/2024 PDF No
F-03187 Prenatal Care Coordination Referral DMS English 12/2023 PDF No
F-03187 Prenatal Care Coordination Referral DMS English 12/2023 Word No
F-03187A Prenatal Care Coordination Referral, Instructions DMS English 12/2023 PDF No
F-03184 Prenatal Care Coordination Training Plan DMS English 06/2023 PDF No
F-03184 Prenatal Care Coordination Training Plan DMS English 06/2023 Word No
F-02436A PrEP Questionnaire DPH English 02/2020 PDF No
F-02436AH PrEP Questionnaire, Hmong DPH Hmong 12/2018 PDF No
F-02436AS PrEP Questionnaire, Spanish DPH Spanish 02/2020 PDF No
F-00704 Prior Authorization - Committee Public Testimony Registration DMS English 08/2016 PDF No
F-00701 Prior Authorization - Drug Attachment for Onabotulinumtoxin A (Botox®) to Treat Chronic Migraines DMS English 08/2019 PDF No
F-00701 Prior Authorization - Drug Attachment for Onabotulinumtoxin A (Botox®) to Treat Chronic Migraines DMS English 08/2019 Word No
F-00701A Prior Authorization - Drug Attachment for Onabotulinumtoxin A (Botox®) to Treat Chronic Migraines Completion Instructions DMS English 08/2013 PDF No
F-00694 Prior Authorization - Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ulcerative Colitis DMS English 12/2013 PDF No
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) DMS English 07/2012 PDF No
F-11038 Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA) DMS English 07/2012 Word No
F-11038A Prior Authorization / Adult Mental Health Day Treatment Attachment (PA/MHDTA): Completion Instructions DMS English 07/2012 PDF No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) DMS English 12/2019 Word No
F-01629 Prior Authorization / Behavioral Treatment Attachment (PA/BTA) DMS English 12/2019 PDF No
F-01629A Prior Authorization / Behavioral Treatment Attachment (PA/BTA) Completion Instructions DMS English 12/2019 PDF No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) DMS English 07/2012 Word No
F-11011 Prior Authorization / Birth to 3 Attachment (PA/B3) DMS English 07/2012 PDF No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) DMS English 08/2015 Word No
F-11096 Prior Authorization / Care Plan Attachment (PA/CPA) DMS English 08/2015 PDF No
F-11096A Prior Authorization / Care Plan Attachment (PA/CPA): Completion Instructions DMS English 09/2015 PDF No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) DMS English 12/2019 PDF No
F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) DMS English 12/2019 Word No
F-11040A Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) Instructions DMS English 12/2019 PDF No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 Word No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 PDF No
F-11029A Prior Authorization / Chiropractic Attachment (PA/CA) Completion Instructions DMS English 10/2008 PDF No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 PDF No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 Word No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 Word No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 PDF No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 Word No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 PDF No
F-00239A Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips Completion Instructions DMS English 07/2015 PDF No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 Word No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 PDF No
F-11030A Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) Instructions DMS English 02/2024 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