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 Sort descending Division Language Release Date File Type Available to Order
F-01247A Prior Authorization Drug Attachment for Hepatitis C Agents Instructions DMS English 07/2020 PDF
F-01248 Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 PDF
F-00238 Prior Authorization Drug Attachment for Hypoglycemics, Glucagon-Like Peptide (GLP-1) Agents DMS English 07/2024 Word
F-00238 Prior Authorization Drug Attachment for Hypoglycemics, Glucagon-Like Peptide (GLP-1) Agents DMS English 07/2024 PDF
F-00238A Prior Authorization Drug Attachment for Hypoglycemics, Glucagon-Like Peptide (GLP-1) Agents Instructions DMS English 07/2024 PDF
F-01749 Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting DMS English 07/2024 Word
F-01749 Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting DMS English 07/2024 PDF
F-01749A Prior Authorization Drug Attachment for Hypoglycemics, Insulins Long-Acting Instructions DMS English 07/2024 PDF
F-00162 Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids DMS English 07/2024 Word
F-00162 Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids DMS English 07/2024 PDF
F-00162A Prior Authorization Drug Attachment for Lipotropics, Omega-3 Acids Instructions DMS English 07/2024 PDF
F-02505 Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors DMS English 07/2024 PDF
F-02505 Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors DMS English 07/2024 Word
F-02505A Prior Authorization Drug Attachment for Lipotropics, Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors Instructions DMS English 07/2024 PDF
F-02371 Prior Authorization Drug Attachment for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists DMS English 07/2019 PDF
F-02371A Prior Authorization Drug Attachment for Migraine Agents, Calcitonin Gene-Related Peptide (CGRP) Antagonists Instructions DMS English 07/2019 PDF
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil DMS English 01/2018 PDF
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil DMS English 07/2018 PDF
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions DMS English 01/2018 PDF
F-00079A Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions DMS English 07/2018 PDF
F-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil® DMS English 01/2017 PDF
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents DMS English 07/2023 PDF
F-00805 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents DMS English 07/2023 Word
F-00805A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Instructions DMS English 07/2023 PDF
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons DMS English 07/2023 PDF
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons DMS English 07/2023 Word
F-03175A Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons Instructions DMS English 07/2023 PDF
F-02537 Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting DMS English 11/2019 Word
F-02537 Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting DMS English 11/2019 PDF
F-02537A Prior Authorization Drug Attachment for Non-Preferred Stimulants, Related Agents - Wake Promoting, Instructions DMS English 11/2019 PDF
F-02573 Prior Authorization Drug Attachment for Wakix DMS English 10/2024 PDF
F-02573 Prior Authorization Drug Attachment for Wakix DMS English 10/2024 Word
F-02573A Prior Authorization Drug Attachment for Wakix, Instructions DMS English 10/2024 PDF
F-01430 Prior Authorization Drug Attachment for Xyrem and Xywav DMS English 12/2021 PDF
F-01430 Prior Authorization Drug Attachment for Xyrem and Xywav DMS English 12/2021 Word
F-01430A Prior Authorization Drug Attachment for Xyrem and Xywav, Instructions DMS English 12/2021 PDF
F-01176 Prior Authorization Fax Cover Sheet DMS English 09/2022 Word
F-01176 Prior Authorization Fax Cover Sheet DMS English 09/2022 PDF
F-02815 Prior Authorization for Hospital Prolonged Stay DMS English 04/2022 Word
F-02815 Prior Authorization for Hospital Prolonged Stay DMS English 04/2022 PDF
F-02815 Prior Authorization for Hospital Prolonged Stay Fax Cover Sheet DMS English 01/2022 Word
F-02815A Prior Authorization for Hospital Prolonged Stay Fax Cover Sheet DMS English 01/2022 PDF
F-11016 Prior Authorization Physician Attachment (PA/PA) DMS English 07/2012 Word
F-11016 Prior Authorization Physician Attachment (PA/PA) DMS English 07/2012 PDF
F-11021 Prior Authorization Request / Hearing Instrument and Audiological Services DMS English 07/2012 PDF
F-11021A Prior Authorization Request / Hearing Instrument and Audiological Services (PA/HIAS2) Completion Instructions DMS English 11/2008 PDF
F-11020 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) DMS English 05/2013 Word
F-11020 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) DMS English 05/2013 PDF
F-11020A Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS1) Completion Instructions DMS English 02/2016 PDF
F-11021 Prior Authorization Request for Hearing Instrument and Audiological Services (PA/HIAS2) DMS English 07/2012 Word

Glossary

 
Last revised December 4, 2024