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Click ‘Get Form’ to open the dhs35 application in the editor.
Begin by entering the date of application completion and the facility name in the designated fields.
Fill in your certification number, county, and main office address, including city, state, and zip code.
Provide contact information for a designated person at your clinic, including telephone number, fax number, and email address.
Indicate whether you wish to have your email published in the provider directory by checking the appropriate box.
Complete sections regarding branch offices if applicable. Attach DQA form F-00191 for each branch office requested.
Review all entries for accuracy before signing as the clinic administrator. Ensure that all required policies are completed.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (83 Votes)
2010	4 Satisfied (27 Votes)

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Why would Wi-DHS call me?

The Texas Department of State Health Services (DSHS) has been restructured to sharpen our focus on public health. Our job is to promote and protect the health of people, and the communities where they live, learn, work, worship, and play.

Why is the Wisconsin Department of Health Services calling me?

The federal government and the Wisconsin Department of Health Services will not call, text, or email you seeking personal or financial information.

Why would the Department of Social Services be calling me?

0:05 1:43 Maybe theyre offering support or resources Social Services isnt just about intervention. They helpMoreMaybe theyre offering support or resources Social Services isnt just about intervention. They help families Thrive. They might also want to discuss a recent application for assistance.

Why would the Department of Human Resources call me?

HR may request to meet with you during an investigation regarding employee problems such as disputes between coworkers or the violation of company policies and procedures. Even if youre not the central subject of the investigation, HR may call you in for a meeting to discuss any knowledge you have on the matter.