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- Background Information Disclosure Appendix & Instructions, HFS-69 & HFS69A. Background
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DEPARTMENT OF HEALTH AND FAMILY SERVICES HFS-69A (Rev. 6/04) STATE OF WISCONSIN BACKGROUND INFORMATION DISCLOSURE APPENDIX INSTRUCTIONS License Holders and Nonclient Residents in Bureau of Quality.
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Developmentally FAQ
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Access to criminal history information can be obtained on the Wisconsin Online Record Check System at http://recordcheck.doj.wi.gov. Adult criminal history information is public record in the State of Wisconsin. Anyone may obtain this information provided they pay the fee established by the Wisconsin Legislature.
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• The Background Information Disclosure (form F-82064) gathers information as required by the Wisconsin Caregiver Background Check Law to help employers and governmental regulatory agencies make employment, contract, residency, and regulatory decisions.
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A caregiver background check is a type of employment background check conducted by licensed community care providers on prospective employees, contractors, and volunteers who will perform direct care duties with vulnerable clients.
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The Caregiver Law requires health care facilities to report incidents of caregiver misconduct and some injuries of unknown source to the Department of Health Services, Division of Quality Assurance. CAREGIVER MISCONDUCT means abuse of a client, neglect of a client, or misappropriation of a client's property.
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• The Background Information Disclosure (form F-82064) gathers information as required by the Wisconsin Caregiver Background Check Law to help employers and governmental regulatory agencies make employment, contract, residency, and regulatory decisions. •
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Use form DJ-LE-250 to request a criminal background check on a single individual. Use form DJ-LE-250A to request background checks on multiple persons. Wisconsin Statutes 19.35(1) and 165.82 provide that any person or entity may request a criminal background check. The subject of the inquiry may be any person.
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