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Nursing Homes: Forms, Memos and Publications

This page includes forms and other helpful resources related to nursing homes. Publications are files or websites with additional information. Division of Quality Assurance (DQA) numbered memos are documents that deal with:

  • Nursing home policies.
  • Guidelines for nursing homes managed by DQA.
  • Information and interpretation of federal and state regulations.

Questions? Email dhswebmaildqa@dhs.wisconsin.gov.

Forms

If a nursing home resident needs a psychotropic medication, guidelines must be followed to get informed consent. Learn more:

Find forms at Informed Consent for Medications F-24277 Series.

Preadmission screen and resident review

If a person being admitted may have a serious mental illness or developmental disability, a special screening is required. The preadmission Level II Screen must be completed before admission. In some cases, a short-term exemption may be granted.

Preadmission Screen and Resident Review: Level 1 Screen, F-22191

Publications

Memos

Memos from the Wisconsin Department of Health Services (DHS)

View our Memos Library to access a wealth of communications issued by DHS regarding policies and procedures and how they should be put into action.

DQA numbered memos

Select a link to view the memo. You can also view the list of all DQA Memos.

For an official paper copy of any numbered memo, email or write:

Official Number Description Issue Date Attachments Obsolete date
21-006
Wisconsin Administrative Code s. DHS 132.42 (3) (a) Pre-employment Screening for Clinically Apparent Communicable Disease
21-004
DHS Requests Nursing Homes Join Hospitals in Wisconsin to Use the EMResource Bed Tracking System for Health Care Entities
21-002
Notice and Requirements for Submitting Four-Year Renewal of Licensee Background Check Information
20-004
Wisconsin Nursing Homes – CMS 1135 Waiver Provisions and Governor Evers Executive Order # 21
20-008
State Licensure Application for Temporary Nursing Facility Expansion Units and Transfer Options during the COVID-19 Public Health Emergency
17-004
Notice of Mandatory Requirement to Submit Four-Year Renewal of Licensee Background Check Information
17-003
Fire Watch, Fire Plan, and Fire Reporting Update
16-008
Centralized Reporting of Client/Patient/Resident Death Determination
16-004
Guidance Reminder Regarding Handheld Devices and the Potential Misuse of Such Devices
16-003
Reminder Nurse Aide Eligibility Requirements
Last revised January 25, 2023