WI DHS F-01247 2025

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4.3 out of 5

46 votes

The document is a Prior Authorization Drug Attachment form for Hepatitis C agents issued by the Wisconsin Department of Health Services. It outlines the necessary information and documentation required from pharmacy providers and prescribers to request prior authorization for hepatitis C drug treatments. The form includes sections for member and prescription information, clinical details, and specific questions regarding the patient's medical history, treatment regimen, and any co-infections. Providers must submit this completed form along with relevant medical records to obtain approval for medication.

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Versions	Form popularity	Fillable & printable
2020	4.4 Satisfied (22 Votes)
2018	4.8 Satisfied (42 Votes)
2017	4.5 Satisfied (36 Votes)
2017	4.3 Satisfied (46 Votes)

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What does Wisconsin DHS do?

DHS is committed to protecting and promoting the health and safety of the people of Wisconsin, making sure everyone can live their best life. DHS oversees Medicaid, the single largest program in the state budget, and other health and social service programs.

What is the mission statement of the Wisconsin DHS?

To protect and promote the health and safety of the people of Wisconsin.

What does DHS stand for in social services?

United States Department of Health and Human Services.

How to contact Wisconsin Department of Health Services Media?

Contacts by Service Area Program/Service Sort descendingContactPhone Official Media Contact DHS Media Contact 608-266-1683 Opioid Treatment Programs Dan Bizjak 608-628-2469 Organ and Tissue Donor Program Martha Mallon 608-261-6854 Organ Transplant Programs, Medicaid Bureau of Clinical Policy and Pharmacy 21 more rows Feb 12, 2024

Who is the head of the DHS in Wisconsin?

The current secretary-designee is Kirsten Johnson, appointed by Governor Tony Evers in February 2023. The Wisconsin DHS is made up of three executive offices and five divisions organized ing to function. WisDHSs main office is located in Madison, and it maintains regional offices throughout the state.