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Wisconsin Department of Health Services

If You Have Complaints about Wisconsin Health Care

Information about Division of Quality Assurance (DQA)

DQA Web Pages Information

Provider Types Regulated by DQA

DQA Listservs

Consumer Information

DQA Facility Directories

DQA Provider Training

DQA Numbered Memos

DHS Forms

Construction/
Remodeling of Health Care Facilities

WI Nurse Aide Training and Registry Info

Caregiver Program/ Background Checks

WI Adult Programs Caregiver Misconduct Registry

Wisconsin Nursing Homes - Forms

Introduction | Rules_&_Regulations | Forms | Providers | Contacts | What's_Happening | Publications | Related Sites

For questions regarding nursing homes, you may E-mail the Division of Quality Assurance

  • Fire Report form DQA F-62500 (PDF, 23 KB):  - To report fires in a facility. Fillable PDF form, select the first field to begin typing. Tab from field to field.  You can print this document but you cannot save it.

  • Level II Preadmission Screening and Resident Review (PASARR) Assessment for Persons with Mental Illness Applying for Admission or Residing in Medicare-Certified Nursing Homes DDE-0378

  • Fire Watch Procedure Template - To use in establishing a Fire Watch procedure any time the fire protection/fire alarm system is taken out of operation.

  • Wisconsin Client Rights and Grievance Procedure

  • Construction/Remodeling of Health Care Facilities  
    Plan Review Requirements

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Last Updated: February 19, 2009