Update regarding Alleged Nursing
Home Resident Mistreatment Report
Effective immediately, all nursing homes must immediately report all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property to the Division of Quality Assurance (DQA) by completing the pdf version of F-62617 Alleged Nursing Home Resident Mistreatment Report.
This form is found at the Caregiver Misconduct Reporting and Investigating Requirements website under Additional Information/Nursing Home Only tab.
The completed report should be sent to the Office of Caregiver Quality by fax at 608-264-6340 or email to DHSCaregiverIntake@wi.gov
If you have any questions, please contact the Office of Caregiver Quality at 608-261-8319 or DHSCaregiverIntake@wi.gov.
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