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Get the free For License Holders and Non Client Residents in DQA-Regulated Facilities

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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F-82069 10/2016 STATE OF WISCONSIN Wis. If you have questions contact the DQA Office of Caregiver Quality at dhscaregiverintake dhs. wisconsin.gov. SECTION 1 REQUIRED INDIVIDUALS. Check the most appropriate box in Section 1. Non Governmental Entities The license holder/legal representative of the entity must submit a BID F-82064 and BID Appendix F-82069 whether or not you have regular direct contact with clients. NOTE If the owner...
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Gather all necessary documents such as identification, proof of residency, and any required supporting documents.
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