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-11018 Prior Authorization Request Form (PA/RF) DMS English 05/2013 PDF
F-11018 Prior Authorization Request Form (PA/RF) DMS English 05/2013 Word
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
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
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) DMS English 04/2017 Word
F-11083 Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA) DMS English 04/2017 PDF
F-11083A Prior Authorization/Brand Medically Necessary Attachment (PA/BMNA): Completion Instructions DMS English 04/2017 PDF
F-11049 Prior Authorization/Drug Attachment (PA/DGA) DMS English 01/2024 PDF
F-11049 Prior Authorization/Drug Attachment (PA/DGA) DMS English 01/2024 Word
F-11049A Prior Authorization/Drug Attachment (PA/DGA), Instructions DMS English 01/2024 PDF
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) DMS English 06/2023 PDF
F-11054 Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA) DMS English 06/2023 Word
F-11054A Prior Authorization/Enteral Nutrition Formula Attachment (PA/ENFA), Completion Instructions DMS English 06/2023 PDF
F-00212 Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment DMS English 02/2010 PDF
F-00212 Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment DMS English 02/2010 Word
F-00212A Prior Authorization/Intensive In-Home Mental Health and Substance Abuse Services Assessment and Recovery/Treatment Plan Attachment Instructions DMS English 12/2019 PDF
F-03327 Prior Authorization/Pediatric Hospital Bed (PA/PHB) DMS English 11/2024 Word
F-03327 Prior Authorization/Pediatric Hospital Bed (PA/PHB) DMS English 11/2024 PDF
F-03327A Prior Authorization/Pediatric Hospital Bed (PA/PHB), Instructions DMS English 11/2024 PDF
F-11034 Prior Authorization/Physician-Administered Drug Attachment (PA/PAD) DMS English 07/2022 PDF
F-11034 Prior Authorization/Physician-Administered Drug Attachment (PA/PAD) DMS English 07/2022 Word
F-11034A Prior Authorization/Physician-Administered Drug Attachment (PA/PAD) Instructions DMS English 07/2022 PDF
F-11075 Prior Authorization/Preferred Drug List (PA/PDL) Exemption Request DMS English 07/2023 PDF
F-11075 Prior Authorization/Preferred Drug List (PA/PDL) Exemption Request DMS English 07/2023 Word
F-11075A Prior Authorization/Preferred Drug List (PA/PDL) Exemption Request, Instructions DMS English 07/2023 PDF
F-01674 Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa DMS English 01/2017 Word
F-01674 Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa DMS English 01/2017 PDF
F-01674A Prior Authorization/Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Hidradenitis Suppurativa Completion Instructions DMS English 01/2017 PDF
F-02433 Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex DMS English 04/2021 PDF
F-02433 Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex DMS English 04/2021 Word
F-02433A Prior Authorization/Preferred Drug List (PA/PDL) for Epidiolex, Instructions DMS English 04/2021 PDF
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs DMS English 07/2024 PDF
F-11092 Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs DMS English 07/2024 Word
F-11092A Prior Authorization/Preferred Drug List (PA/PDL) for Growth Hormone Drugs Instructions DMS English 07/2024 PDF
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable DMS English 07/2020 Word
F-02668 Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable DMS English 07/2020 PDF
F-02668A Prior Authorization/Preferred Drug List (PA/PDL) for Headache Agents, Triptans Non-Injectable Instructions DMS English 07/2020 PDF
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical DMS English 01/2025 Word
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical DMS English 01/2025 PDF
F-02572A Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical Instructions DMS English 01/2025 PDF
F-00622A Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Injectable Completion Instructions DMS English 07/2015 PDF
F-00280A Prior Authorization/Preferred Drug List (PA/PDL) for Migraine Agents, Other Completion Instructions DMS English 07/2015 PDF
F-00079A Prior Authorization/Preferred Drug List (PA/PDL) for Modafinil and Nuvigil Completion Instructions DMS English 01/2017 PDF
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants DMS English 01/2017 Word
F-01672 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants DMS English 01/2017 PDF
F-01672A Prior Authorization/Preferred Drug List (PA/PDL) for Non-Preferred Stimulants, Instructions DMS English 01/2022 PDF
F-11077 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) DMS English 01/2018 PDF
F-11077 Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) DMS English 01/2018 Word
F-11077A Prior Authorization/Preferred Drug List (PA/PDL) for Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Instructions DMS English 01/2022 PDF
F-00081 Prior Authorization/Preferred Drug List (PA/PDL) for Opioid Dependency Agents—Buprenorphine DMS English 07/2024 PDF

Glossary

 
Last revised December 4, 2024