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Wisconsin Department of Health Services

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 Welcome to the DQA Online Complaint Intake System  

  You may use this system to register a complaint about care received at a nursing home, assisted living facility (adult family home, community based residential facility, residential care apartment complex, or adult day care), hospital, or other facility regulated by the Division of Quality Assurance. Your concerns will be reviewed to determine if they identify noncompliance with federal and/or state regulations. If there is sufficient information to warrant an investigation, the complaint will be assigned to a surveyor/investigator who will conduct an unannounced investigation. If you choose to provide personal identifying information (PII) such as your name, address or telephone number as part of this complaint intake system, you may be contacted by the surveyor/investigator for additional information prior to the complaint being opened or during the investigation process. If PII is provided, you will receive an acknowledgement letter indicating your complaint has been received and an investigation will occur. You will also receive a letter regarding the results of the investigation. Note: If you provide any personal identifying information (PII), the law will likely require our agency to release this information in the event of a public records request for the complaint.

Note: If you are a Division of Quality Assurance regulated facility, you must use the Department's Incident Report form to report incidents of alleged misconduct and injuries of unknown source. Completion of this online survey does not meet entity reporting requirements. Please see http://www.dhs.wisconsin.gov/caregiver/contacts/Complaints.htm for more information.

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