Get Wisconsin Form F 00059

Wisconsin Form F 00059 is the outpatient mental health clinic application, designed to ensure compliance with the necessary regulations in Wisconsin. This guide provides clear, step-by-step instructions for completing the form online, making the process straightforward for users, regardless of their legal background.

Follow the steps to fill out the Wisconsin Form F 00059 online

1. Press the ‘Get Form’ button to obtain the Wisconsin Form F 00059 and open it in your preferred digital editor.
2. Begin by entering the date the application is completed in the designated field.
3. Indicate whether this is an initial certification or recertification by selecting the appropriate checkbox.
4. Fill in the name of the facility, county, and main office address, including street, city, state, and zip code.
5. Input the mailing address for the main office if it differs from the location entered in the previous step.
6. Provide the name of the contact person, along with their telephone number, fax number, and email address.
7. Confirm whether the website can be published in the provider directory, indicating yes or no.
8. If applicable, attach the DQA form F-00191 to request branch offices and provide the necessary details.
9. Affirm compliance with the required accreditation by specifying the relevant details and dates.
10. Review all statements made in the application, then sign and print the name of the clinic administrator along with the date of signing.
11. Complete the staffing requirements section and the sections related to clinical supervision, policies, and treatment plans as applicable.
12. Once all fields have been filled out, ensure the application is complete and accurate before finalizing.
13. You can now save the changes made, download the completed form, print it for physical submission, or share it as needed.

Start filling out the Wisconsin Form F 00059 online to streamline your application process.