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Wisconsin dhs f 00438 fill in 2026

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The document outlines the verification criteria for Community Substance Abuse Service (CSAS) professionals in Wisconsin, detailing the qualifications required for clinical supervisors, medical directors, and physicians involved in addiction treatment. It includes sections for general information, verification of credentials, and attestation by applicants and agency directors. Additionally, it provides guidelines on training requirements and knowledge areas necessary for effective addiction counseling and supervision, emphasizing compliance with state regulations.

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Click ‘Get Form’ to open the Wisconsin DHS F-00438 form in the editor.
Begin with Part I – General Information. Fill in your name as the applicant, the date of application completion, and details about your facility including address, city, state, zip code, county, and contact information.
Proceed to Part II – Verification of Criteria for Clinical Supervisor. Indicate your qualifications by selecting 'Yes' or 'No' for each statement regarding your certifications and licenses. Ensure you enter your certification and license numbers where applicable.
Continue to Part IV – Attestation. As the applicant, attest that all provided information is true by signing and dating the form. If applicable, have the Agency Director or Board Chairman complete their section with their signature and date.

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