Opening an Adult Day Care FacilityWisconsin DepartmentOpening an Adult Day Care FacilityWisconsin De 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Participant Information section. Enter the full name, age, preferred name, birth date, and address. Ensure that you provide accurate contact details including phone number and birthplace.
3. Proceed to the Caregiver Information section. Input the caregiver's name, address, and phone numbers. It's essential to list two emergency contacts who are not caregivers.
4. In the Health Information section, detail any primary health diagnoses and significant conditions. Include allergies and information about primary physicians and hospitals.
5. Complete the Activities of Daily Living section by checking the appropriate boxes that reflect the participant's abilities in various activities.
6. Fill out the Social/Financial Information section with details about social services received, caseworker information, and financial assistance needs.
7. Finally, complete the Registration Information section indicating planned attendance days and hours. Sign and date where indicated before submitting your form.

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