Community Based Residential Facility (CBRF) Residents' Rights - dhs wisconsin 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the facility's name, license number, address, city, zip code, telephone number, and fax number in the designated fields.
3. In the section for complaints, provide the original date of the report and details about the incident including the approximate date and disposition date.
4. Fill in the full names of individuals initiating the complaint, residents involved, and any witnesses or informants.
5. Describe the incident briefly in the provided space, ensuring to include relevant details such as date and time. Conclude with a summary of how the matter was resolved.
6. Finally, sign and print your name along with your title at the bottom of the form before submitting it as required.

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