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Dane County Department of Human Services Provider Hub

Monthly Client Reporting

Before getting started with your current client services reporting, please view the Monthly Client Services Report Instruction Manual, which includes additional directions for submitting your reports. Monthly reports are due on the tenth (10th) of the following month.

Mental Health

  • Monthly Client Services Report – Mental Health (610 Form)
    Version 4.4.9, revised 2016-10-19
    If required by their contract, service providers must use the 610 Form to collect units of service and opening and closing reason information on clients receiving publicly funded services. The Mental Health Episode Form below is also required.
     
  • Mental Health Episode Form
    If a mental health service provider is required to submit Monthly Client Service Reports, they must also submit Mental Health Episode Reports. These reports are used to collect qualitative information required by the State for people served through the public mental health system. Data is to be collected at the beginning of an episode of service. Updates must be completed at six-month intervals thereafter for clients receiving ongoing comprehensive services.

Alcohol and Other Drugs (AODA)

  • Monthly Client Services Report – AODA (610 Form)
    Version 4.4.9, revised 2016-10-19
    If required by their contract, AODA service providers must use the AODA Monthly Client Report to collect units of service information on consumers receiving alcohol and other drug abuse services. The AODA Episode Form below is also required.
  • AODA Episode Form
    If an AODA service provider is required to submit monthly AODA Client Service Reports, they must also submit AODA Episode Reports. These reports are used to capture qualitative information required by the State on persons receiving publicly funded AODA services.

  • State of Wisconsin PPS AODA Data Collection site
    For a complete listing of the options and codes to use when filling out the AODA episode form, please refer to this site.

Hospitalization/Institutional Lapse

Other Services

Monthly Client Services Report – Other Services (610 Form)
Version 4.4.9, revised 2016-10-19
If required by their contract, service providers must use the Monthly Client Services Report to collect units of service and opening and closing reason information on clients receiving publicly funded services. 

If you have questions about these forms or monthly reporting requirements, please call your designated data entry contact. Monthly reports are due on the tenth (10th) of the following month via fax or mail.

Mail:
Data Entry Contact
Department of Human Services
1202 Northport Drive
Madison WI 53704

Fax:
Send to your designated data entry contact at (608) 242-6288.