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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance F-62671 (06/2015) STATE OF WISCONSIN ADULT FAMILY HOME (AFH) INITIAL LICENSURE CHECKLIST Name Facility Date Form Completed (MM/dd/yyyy).

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How to fill out the Wisconsin AFH forms online

Completing the Wisconsin Adult Family Home (AFH) Initial Licensure Checklist online is an essential step for ensuring compliance with state regulations. This guide will walk you through each section of the form, providing clear instructions to help you submit a complete and accurate application.

Follow the steps to complete your Wisconsin AFH forms successfully

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Fill in the name of the facility in the provided field. It is critical to ensure accuracy as this will be used in official documentation.
  3. Enter the date the form is completed in the MM/dd/yyyy format. This date is important for processing the application.
  4. In the street address field, input the complete address of the facility. Ensure that you include any required details such as suite or apartment numbers.
  5. Specify the city and county where the facility is located. This helps in identifying the jurisdiction of the application.
  6. Designate the reviewer’s name in the appropriate field. This is usually the person responsible for the application or compliance review.
  7. Review the checklist of required items outlined in Section A. Confirm that you have all the necessary documentation, including forms and evidence requested.
  8. As you gather the required documents, ensure that they are completed and signed where necessary, including forms like DQA form F-60945 and the financial ability evidence.
  9. After completing all fields and gathering necessary documents, review the entire form for accuracy. Make any needed corrections or updates.
  10. Once you are satisfied with the form, use the options available to save your changes, download the completed form, print it for your records, or share it as needed.

Complete your Wisconsin AFH forms online today to ensure a smooth application process.

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Group homes or “personal care facilities” with more than three residents unrelated to the property owner in a residential community in the State of Texas must be properly licensed through the Texas Department of Aging and Disability Services (DADS).

The Wisconsin Department of Health Services (DHS) includes the Division of Quality Assurance (DQA)....The DQA is responsible for regulating facilities that serve: Frail elderly. People with developmental, mental health, physical, or sensory disabilities. Individuals with substance abuse problems.

High school diploma or high school equivalency certificate per RCW 288.50.536. Long-term care worker. Documentation to show you are Exempt OR. ... Experience. ... Adult Family Home Administrator Training Class. Prospective Provider Orientation class. CPR. First Aid (Not required for licensed nurses) Food Safety.

You must provide a Medical Clearance Request (BCAL 3704-AFC), or its equivalent, completed by a licensed physician or their designee for each license applicant and each responsible person. It cannot be dated more than 6 months prior to license issuance.

If you are interested in starting a group home in your home, you can contact the Ohio Department of Health, which licenses adult care facilities and adult care homes, at (614) 466-7713. Such homes provide personal care services and supervision to all vulnerable adults, not just those with mental retardation.

A service provider interested in opening an Adult Family Home must first make application to the State of Wisconsin for licensing. A copy of that license specifying the address, number of clients, and client type must be provided to the Development Center staff when applying for an occupancy certificate.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232