DHS Website
Under Mental Health Treatment Programs you will find many useful resources at your fingertips.
Forms Library and Webcast Library are the two most important resources. Several important forms are listed below for your convenience, but take a look at the entire list to find other forms that can assist your organization.
Forms Library – forms can be located by using the lists located in the left column:
alphabetic forms lists – form by name
numeric lists – form by number
division/office numeric lists – form by division/office
Division/Office Links of greatest interest for clinics and residential treatment facilities:
DCTS - Division of Care and Treatment Services
DQA – Quality Assurance
DMS – Division of Medicaid Services (BadgerCare)
NOTE: many forms are available as a PDF or a Word Doc that can be edited for your organization’s use; some forms are available in Spanish and Hmong
DCTS
F-22538 – PDF – Consent to Film or Tape
F-22538 – Word – Consent to Film or Tape
F-22538S – PDF – Consent to Film or Tape - Spanish
F-24277 BRD – PDF - Informed Consents for Medications: Brand Name Index
F-24277 GEN – PDF - Informed Consents for Medications: Generic Name Index
F-26003 – PDF – Notice of Privacy Practices - Treatment Facilities
F-26030 – Word – Notice of Privacy Practices - Treatment Facilities
F-26003H- PDF – Notice of Privacy Practices - Treatment Facilities - Hmong
F-26003S – PDF – Notice of Privacy Practices - Treatment Facilities - Spanish
F-26100 – PDF – Clients Rights Limitation or Denial Documentation
DQA
F-62504 – Community Based Substance Abuse Services Or Mental Health Clinic Certification Application
F-62520 – PDF – Caregiver Program Compliance Check
F-62520 – Word – Caregiver Program Compliance Check
DMS
F-00212 – Word - ForwardHealth Prior Authorization Intensive In-Home MHSA Services Assessment and Recovery / Treatment Plan (health check has to be done as a prior auth issue for in-home treatment of children)
F-00212a – PDF - Completion Instructions
HCF
F-11018 – PDF - ForwardHealth Prior Authorization
F-11018 – Word - ForwardHealth Prior Authorization
F-11031 - PDF - Wisconsin Medicaid Prior Authorization / Psychotherapy Attachment (PA/PSYA)
F-11031 - Word - Wisconsin Medicaid Prior Authorization / Psychotherapy Attachment (PA/PSYA)
F-11031a – PDF - Completion Instructions
F-11036 – Word - ForwardHealth Prior Authorization / In-Home Treatment Attachment (PA / ITA)
F-11103 – PDF - Optional Outpatient Mental Health Assessment and Treatment / Recovery Plan
F-11103 – Word - Optional Outpatient Mental Health Assessment and Treatment / Recovery Plan
F-11103a – PDF - Completion Instructions (includes data elements required by Medicaid)
HFS
F-82009 – PDF – Confidential Information Release Authorization
F-82009 – Word – Confidential Information Release Authorization
Several Versions exist of this Form. Visit HFS forms page for more information.
F-82064 – PDF – Background Information Disclosure and Instructions (caregiver background check)
F-82064 – Word – Background Information Disclosure and Instructions (caregiver background check)
Webcast Library – webcasts can be viewed online at your convenience and at no cost. The webcasts cover meetings, events and presentations by DHS staff and partners in the community.