Community-Based Residential Facilities: Forms
New online licensure and certification system for health and residential care providers
The Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA) launched the DHS DQA Provider Portal, a new online system for licensure/certification, background checks, plan reviews, and other provider applications for certain users. Visit our webpage for more information.
Portal outage
Routine system maintenance is happening on Sunday, January 11, 2026, at 9 p.m. for up to 3 hours. The DHS DQA Provider Portal and associated systems will be unavailable during this time. We appreciate your understanding and support.
This page includes forms related to community-based residential facilities (CBRFs) in Wisconsin. Select a link to learn more.
- Assisted Living Facility Request for Waiver, Approval, Variance, or Exception, F-62548
- Assisted Living Facility Self-Report, F-02208
- CBRF Fire Inspection, F-60795
- CBRF Resident Rights Complaint Report, F-62430
- CBRF Resident Satisfaction Evaluation, F-62372
- Client Rights Office - Find forms and other information.
- Construction/Remodeling Plan Review for Health Care Facilities - Find requirements and additional information.
- Health Care Facility Fire Report, F-62500
- Resident Evacuation Assessment, F-62373
- Self Supervision Evaluation and Waiver Request, F-60309
- Significant Change in Health Screening Instrument Model Form, F-62370
- Waiver of Hospice or Home Health Services by a Terminally Ill Resident of a CBRF, F-62369