F-62381 - Wisconsin Department of Health Services - Wisconsin.gov - dhs wisconsin 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the facility's name and address in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the name of the person completing the form along with their telephone number and zip code. This contact information is essential for any follow-up.
4. Review each compliance section carefully. Check the boxes next to each statement that confirms your facility's adherence to Wisconsin Administrative Code, DHS 89.
5. For each operational code, ensure that you have documented evidence ready, such as policies and procedures, staffing plans, and service agreements.
6. Once all sections are completed, sign and date the form at the bottom. Make sure to print your name and title clearly.

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