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Wisconsin Caregiver Background Check Form, Stats. Complete and return the entire form and attach explanations as specified by employer or governmental regulatory agency. Make employment and licensing decisions based on the results of the background checks in accordance with the requirements and prohibitions in the law. Completion of this form to verify your eligibility for employment/service as a “caregiver” is required by Wis. Visit our webpage for more information. Wisconsin Caregiver Law NWTC is required to comply with the Wisconsin Caregiver Law (1997 WISCONSIN ACT 27). 065 and Wis. Caregiver Background Check Documentation Requirements Wisconsin Department of Health Services / Division of Quality Assurance / Office of Caregiver Quality P-03513 (10/2025) BACKGROUND INFORMATION DISCLOSURE (BID) For Instructions, see F-82064A. May 5, 2024 · The next step in the background check process is for the provider to verify the information on the BID form (in addition to the social security number) by requesting a caregiver background check from the DOJ Crime Information Bureau. It asks about your criminal, abuse, neglect, and credential history, and may result in denial or termination if you provide false information. Have you ever requested a rehabilitation review with the Wisconsin Department of Health Services, a county department, a private child placing agency, school board, or DHS-designated tribe? May 13, 2026 · The Caregiver Misconduct Registry is a record of the names of nurse aides and other noncredentialed caregivers with a substantiated finding of caregiver misconduct. View a listing of caregiver background check forms and publications for Wisconsin. The completion of a caregiver background check includes the review of criminal records for convictions of serious crimes or a history of improper behavior. INSTRUCTIONS 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. 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. If Yes, list the date of each check, and the name, address, and phone number of the person, facility, or government agency that conducted each check. Dec 18, 2025 · Search for a VA form by keyword, form name, or form number. . § 50. Apr 7, 2025 · Wisconsin's Caregiver Law requires background and criminal history checks of certain caregivers and requires regulated entities to report incidents of misconduct. Admin Code ch. BACKGROUND INFORMATION DISCLOSURE (BID) For Instructions, see F-82064A. Feb 24, 2026 · New online licensure and certification system for health and residential care providers The Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA) launched the DHS DQA Provider Portal, a new online system for licensure/certification, background checks, plan reviews, and other provider applications for certain users. gm4v8, w7qw, zjt5g, lhzgw, 7vcr2gc, ntk, vnwhqd, dsbe5p, nr, 0k8,