Form HFS1413AS or the "Programa De Exclusion - Proveedor - Acuerdo Para Participar En El Programa De Asistencia Medica De Illinois" is a form issued by the Illinois Department of Healthcare and Family Services.
Download a PDF version of the Form HFS1413AS down below or find it on the Illinois Department of Healthcare and Family Services Forms website.
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.