Fill Out Your Wisconsin F 62019 Template

The Wisconsin F-62019 form serves as a crucial document for individuals and organizations seeking to obtain a license for various types of healthcare facilities, including nursing homes, facilities for the developmentally disabled, and institutes for mental disease. This form is designed to gather essential information about the facility, its administration, and ownership structure. Applicants must provide details such as the facility's name, address, and type of care offered, along with the specific license type they are applying for—whether it be for initial licensure, a change of ownership, or a replacement facility. Additionally, the form requires information about the facility's administrator, director of nursing, and medical director, ensuring that qualified personnel are in place to oversee operations. The licensing process is governed by state regulations, which mandate that all requested information be submitted before a license can be issued. This form also collects personally identifiable information, which is strictly used for determining eligibility and statistical purposes. Completing the F-62019 form accurately is a vital step in ensuring compliance with Wisconsin's health and safety standards.