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Dane County Department of Human Services Provider Hub
CCS Provider Forms
CCS Module Login Page
Forms for All CCS Staff
Agency Fax Cover Sheet
[revised 10/31/2018]
C-SSRS
Release of Information (ROI)
form-enabled Microsoft Word version
non-fillable PDF version
Supervision / Clinical Collaboration Log
CCS Service Provider Orientation & Training
CCS Service Provider Orientation Checklist
On-going Training Log
Forms for Service Facilitation Staff
Physician Prescription for CCS
[added 02/06/2018]
Assessment and Recovery Team Template
[revised 02/12/2018]
C-SSRS
Assessment Summary Template
[revised 4/26/2016]
Irretrievable Documents Form
Transfer Summary
[revised 11/2023]
Recovery Team Meeting Roster Template
[revised 01/27/2019]
CCS Discharge Summary
Dane County Mental Health Consumer Status Data Form
CCS Fiscal Information and Forms
Dane County CCS Fiscal Reports Workbook
Direct Deposit Authorization Agreement
Dane County CCS Supplemental Payment and COLA Procedures