Updated Background
Information
Disclosure Form (F-82064)
The Department of Health Services, Division of Quality Assurance (DQA) has revised the Background Information Disclosure (BID) form F-82064. License applicants, employees, contractors and non-client residents must complete the BID form as part of the required caregiver background check process.
The Caregiver Law, under Wis. Stat. § 50.065 require regulated facilities/entities to complete two types of caregiver background checks:
- Those completed by employers on their employees and contractors at the time of hire.
- Those completed by DQA as part of the licensure process for a DQA regulated health care facility on license applicants/license holders, some principal officers, and non-client residents.
Entities must maintain the background check documents for each employee or contractor. The records must be readily available to DQA staff upon request. Refer to the Caregiver
Background Check Process webpage for complete information regarding the employee background check process and the license holder background check process.
Please email the Office of Caregiver Quality if you have any questions.
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