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

Provider Search

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

Clinical Laboratories - Forms

Introduction | Forms | Contacts | Publications

Contact the Division of Quality Assurance for questions regarding the following forms:

• CLIA Application for Certification (exit DHS)
  (also see the Federal Medicaid CLIA web site (exit DHS))

The following items are fillable PDF forms, select the first field to begin typing. Tab from field to field. You can print these changed documents but you cannot save them.

• Application for Blood/Urine Alcohol Analysis Procedure Approval (PDF, 15 KB)

• Laboratory Application for Approval to Perform Alcohol Tests (PDF, 13 KB)

• Analyst Application for Approval to Perform Alcohol Tests (PDF, 18 KB)

Also please review:

Wisconsin Licensing Portal Information:

• Alcohol Test Analyst (exit DHS)

• Blood/Urine Alcohol Analysis Procedure Approval (exit DHS)

• Laboratory to Perform Alcohol Tests (exit DHS)

• Laboratory, Clinical - Improvement Amendments of 1988 (CLIA) Application (exit DHS)

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Last Updated: October 22, 2012