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Wisconsin Department of Health Services

If You Have Complaints about Wisconsin Health Care

Information about Division of Quality Assurance (DQA)

Provider Types Regulated by DQA

DQA Listservs

Provider Search

Provider Training

DQA Numbered Memos

DHS Forms

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 | Publications | Webcasts | Related Sites

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

A Pre-admission Screen and Resident Review (PASARR) Level 1 Screen must be completed prior to admission to a nursing facility admission to determine if a person reasonably is suspected of having a serious mental illness or a developmental disability, which necessitates a PASARR Level II Screen prior to admission unless a short-term exemption, per Wisconsin PASARR policies, is appropriate

Pre-admission Screen and Resident Review (PASARR) Level 1 Screen: Word Fillable Format, PDF Format

Fire Report form DQA F-62500 (Word, 78 KB) - Fillable form with contacts to assist the reporting of fires in a healthcare facility.

Fire Watch memorandum DQA 12-013 - Outlines the minimum procedures for when a required sprinkler or fire alarm system is out of service.

Wisconsin Client Rights and Grievance Procedure

Construction/Remodeling of Health Care Facilities:  
Plan Review Requirements


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Last Updated: July 17, 2013