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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F62548 (10/2016)STATE OF WISCONSIN ASSISTED LIVING FACILITY WAIVER, APPROVAL, VARIANCE OR EXCEPTION REQUEST Completion of this form is voluntary.
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What is ASSISTED LIVING FACILITY WAIVER, APPROVAL, VARIANCE OR EXCEPTION REQUEST Form?

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ASSISTED LIVING FACILITY WAIVER, APPROVAL, VARIANCE OR EXCEPTION REQUEST template instructions

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Assisted living facility waiver is a program that allows individuals to receive certain services in a residential facility.
Individuals who are seeking to receive services in a residential facility may be required to file an assisted living facility waiver.
To fill out an assisted living facility waiver, individuals must provide information about their medical needs, income, and other relevant details.
The purpose of assisted living facility waiver is to provide individuals with necessary care and services in a residential setting.
Information such as medical history, income, and personal details must be reported on an assisted living facility waiver.
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