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State of Wisconsin Dept. of Health ServicesDate: 5/6/2016 G0564 DPH16Page 1 of 13GRANT REQUEST FOR APPLICATION STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES DIVISION OF PUBLIC HEALTH OFFICE OF
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G-0564 DPH-16 is a specific form used for reporting certain information to the Department of Public Health.
Certain healthcare facilities are required to file g-0564 DPH-16 as part of their reporting requirements.
To fill out G-0564 DPH-16, healthcare facilities need to gather the required information and input it accurately into the form.
The purpose of G-0564 DPH-16 is to ensure that healthcare facilities are compliant with reporting requirements and that accurate information is provided to the Department of Public Health.
Information such as patient demographics, services provided, and other relevant data must be reported on G-0564 DPH-16.
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