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Data Collection (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 form, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-01951 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis DMS English 05/2023 Word No
F-01951A Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis (JIA), and Psoriatic Arthritis Instructions DMS English 05/2023 PDF No
F-03224 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Uveitis DMS English 10/2023 PDF No
F-03224 Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Uveitis DMS English 10/2023 Word No
F-03224A Prior Authorization Drug Attachment for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Uveitis, Instructions DMS English 10/2023 PDF No
F-02666 Prior Authorization Drug Attachment for Headache Agents, Acute Treatment DMS English 07/2022 PDF No
F-02666 Prior Authorization Drug Attachment for Headache Agents, Acute Treatment DMS English 07/2022 Word No
F-02666A Prior Authorization Drug Attachment for Headache Agents, Acute Treatment Instructions DMS English 07/2022 PDF No
F-02667 Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment DMS English 07/2022 PDF No
F-02667 Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment DMS English 07/2022 Word No
F-02667A Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment Instructions DMS English 07/2022 PDF No
F-01247 Prior Authorization Drug Attachment for Hepatitis C Agents DMS English 07/2020 Word No
F-01247 Prior Authorization Drug Attachment for Hepatitis C Agents DMS English 07/2020 PDF No
F-01247A Prior Authorization Drug Attachment for Hepatitis C Agents Instructions DMS English 07/2020 PDF No
F-01248 Prior Authorization Drug Attachment for Hepatitis C Agents Renewal DMS English 08/2016 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-00079 Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions DMS English 01/2018 PDF No
F-00079 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 PDF No
F-03175 Prior Authorization Drug Attachment for Multiple Sclerosis (MS) Agents, Interferons DMS English 07/2023 Word 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 04/2021 Word No
F-02573 Prior Authorization Drug Attachment for Wakix DMS English 04/2021 PDF No
F-02573A Prior Authorization Drug Attachment for Wakix, Instructions DMS English 04/2021 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 PDF No
F-02815 Prior Authorization for Hospital Prolonged Stay DMS English 04/2022 Word 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-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-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 Word No

Glossary

 
Last revised December 8, 2023