Form IL462-2012 Out-Patient Certificate - Illinois

Form IL462-2012 Out-Patient Certificate - Illinois

What Is Form IL462-2012?

This is a legal form that was released by the Illinois Department of Human Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form IL462-2012 Out-Patient Certificate?A: Form IL462-2012 Out-Patient Certificate is a document used in Illinois for out-patient medical services.

Q: What is the purpose of Form IL462-2012 Out-Patient Certificate?A: The purpose of this form is to certify that the individual named on the form requires out-patient medical services.

Q: Who needs to fill out Form IL462-2012 Out-Patient Certificate?A: The form needs to be filled out by a licensed physician, physician assistant, or an advanced practice registered nurse.

Q: How do I fill out Form IL462-2012 Out-Patient Certificate?A: You need to provide the necessary information about the individual requiring out-patient medical services and certify the need for such services.

Q: Is there a fee for submitting Form IL462-2012 Out-Patient Certificate?A: No, there is no fee for submitting this form.

Q: What do I do with the completed Form IL462-2012 Out-Patient Certificate?A: You need to submit the completed form to the appropriate medical provider or facility.

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Form Details:

  • Released on March 1, 2011;
  • The latest edition provided by the Illinois Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IL462-2012 by clicking the link below or browse more documents and templates provided by the Illinois Department of Human Services.

Download Form IL462-2012 Out-Patient Certificate - Illinois

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  • Form IL462-2012 Out-Patient Certificate - Illinois, Page 1
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