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Nursing Homes: Forms, Memos and Publications

Scam targeting U.S. Bank customers

DHS is aware of an organized impersonation scam that targets U.S. Bank customers. Impersonators are contacting customers by phone, posing as representatives from the U.S. Bank Fraud Department. They may claim issues with recently initiated wire transfers. The DHS DQA Provider Portal uses U.S. Bank for the payment of fees. Please be aware of this impersonation scam if you are paying fees through the DHS DQA Provider Portal.

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. Contact dhswebmaildqa@dhs.wisconsin.gov for a copy of the screening tool.

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:

Memo number Title Issue date Discontinued date Attachments Edit
25-001 Background Check Renewals for Entity Operators & Non-Client Residents
23-002 Fire Watch, Fire Plan, and Fire Reporting Update
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

Glossary

 
Last revised January 2, 2026