Illinois Department of Healthcare and Family Services Forms

This form is used for completing a questionnaire regarding compression/burn garments in the state of Illinois.

This Form is used for obtaining prior authorization in Illinois for gender-affirming services. It is necessary for individuals seeking these services to complete this form in order to receive coverage from their insurance provider.

This form is used for filing an appeal and requesting a hearing for an involuntary discharge notice in Illinois.

This form is used for Abe Partner Portal Registration in the state of Illinois.

This form is used for making adjustments to the NIPS program in the state of Illinois.

This form is used for making standardized referrals for early intervention services in Illinois.

This form is used for requesting a certified copy of the Administrative Support Order in Illinois.

This form is used for obtaining consent to release confidential information in the state of Illinois.

This form is used for rescinding the voluntary acknowledgment of paternity or denial of parentage in Illinois. It is available in both English and Spanish.

This form is used for obtaining prior authorization for Applied Behavioral Analysis (ABA) services in the state of Illinois. ABA is a type of therapy that helps individuals with autism spectrum disorder improve their social, communication, and behavioral skills. Prior authorization is required to ensure coverage and reimbursement for ABA services.

This form is used for Illinois residents to apply for payment of Medicare premiums, deductibles, and coinsurance through mail-in application.

This form is used for applying to register as a voter in the state of Illinois.

This form is used for prescribing power mobility devices and custom manual wheelchairs in the state of Illinois.

This document is for healthcare providers in Illinois who have completed training in Healthchoice and/or Mmai programs. It is used to attest their completion of the training.

This Form is used for submitting an interim relief application and obtaining consent in the state of Illinois.

This form is used for public testimony registration and disclosure of conflicts of interest in Illinois.

This form is used for requesting long-term care days at a hospital in Illinois.

This form is used for notifying the Illinois Department of Healthcare and Family Services (HFS) of a patient's discharge from hospice care.

This form is used for reviewing and assessing the nutrition needs of individuals who require medical food in the state of Illinois.

This document is used in Illinois to determine the amount of financial support one party must provide to the other in cases of divorce or child custody. It helps calculate the appropriate level of support based on factors such as income and expenses.

This document is a worksheet used in Illinois to calculate the shared physical care support obligation for child custody cases. It helps determine the financial responsibility of each parent based on the amount of time they spend with the child.

Este formulario se utiliza como una referencia estandarizada para la intervención temprana en Illinois.

This form is used for receiving a notice about the decision on a medical assistance application in Illinois.

This Form is used for documenting the Handicapping Labio-Lingual Deviation Index (Hld) score in Illinois.

This form is used for notifying the HFS of Illinois Medicaid about a continuing benefit period and recertification of terminal illness for the hospice benefit.

This Form is used for ordering human donor milk in Illinois. It is a questionnaire that needs to be filled out every 6 months to place a new order.

This document provides information on specific items that pertain to the state of Illinois. It is particularly relevant for residents or businesses in Illinois who need to understand the state-specific requirements or regulations.

This form is used for authorizing the disclosure of all Kids/Familycare information in Illinois. It allows individuals to give consent for the release of their children's and family's healthcare information to third parties.

This form is used for applying for Child Support Services (Title IV-D) in Illinois if a parent does not live with the child.

This Form is used for requesting prior authorization for pharmacy services under the Illinois Medicaid program.

This type of document is a Spanish form used for authorization to request an HFS Agent in Illinois.

This Form is used for obtaining consent from an individual in Illinois for providing assistance by phone.

This form is used for authorizing direct debit payments in the state of Illinois.