Get Wi F-22191 2015-2025

Filling out the WI F-22191 form, which pertains to the preadmission screening and resident review for mental health and developmental disabilities, is essential for ensuring compliance with federal regulations. This guide will provide clear, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by entering the resident's name in the designated field. Ensure the name matches the identification documents.
3. Input the resident’s birthdate using the format mm/dd/yyyy. Double-check to verify accuracy.
4. Fill in the resident's Social Security number in the appropriate field. Ensure to keep this information secure.
5. Provide the full address of the resident, including street, city, state, and zip code, specifically for preadmission screens.
6. Enter the nursing facility's name and complete the associated address information similarly.
7. If applicable, include the guardian’s or health care agent’s name and their address, followed by their telephone numbers for home and work.
8. Carefully review Section A. Check the appropriate box based on the responses to the screening questions regarding mental illness or developmental disability.
9. Sign the form where indicated by the staff member completing the screen, including their title and date of completion.
10. Finalize the process by saving your changes, downloading, printing, or sharing the completed form as needed.

Complete your documentation online to ensure a smooth and compliant process.