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DEPARTMENT OF HEALTH SERVICES Division of Medicaid ServicesSTATE OF WISCONSINF01812 (9/2020)WISCONSIN MEDICAID PROGRAM 2020 NURSING HOME COST REPORT SCHEDULE 1: Facility & Preparer Information 0 SECTION

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Autumn Lake Healthcare is a skilled nursing facility.

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The facility administrators or designated individuals are required to file autumn lake healthcare forms.

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The purpose of autumn lake healthcare forms is to report important data and information about the operations and services provided by skilled nursing facilities.

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Information such as patient census, staffing levels, quality measures, and financial data must be reported on autumn lake healthcare forms.

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