State of Illinois Department of Healthcare and Family Services Name: Address:Facility Name: Birth Date:Social Security #: Case #, if known:Recipient #, if known: Date of screening: Determination of Need Score: NOTE: Screening is valid for 90 days from date of screening.

Interagency Certification of Screening Results HFS 2536 (pdf) Involuntary Discharge Notice of Appeal and Request for Hearing HFS 3732 (pdf) Irrevocable Assignment of Benefits of Life Insurance Policy HFS3195(pdf) Knee Brace Questionnaire HFS 2305M (pdf) Laboratory / Portable X-Ray Invoice Example Only HFS 2211 (OCR) (pdf)

2004年8月20日 · Receipt of Interagency Certification of Screening Results (Form 2536), indicating the need for care, verifies that the screening is met. (Facility, Customer's Physician, or Other Interested Party) Notifies agents of DoA, DHS, or HFS that a Form 2536 needs to be completed and sent to the FCRC.

HFS 2536 Interagency Certification of Screening Results (pdf) HFS 2538B llinois Department on Aging (IDoA) Notification (pdf) HFS 2538BS Illinois Department on Aging (IDoA) Notification (Spanish) (pdf) HFS 2538C Using Department on Aging (DoA) Community Care Program (CCP) Services to Meet Spenddown (pdf)

the Illinois Department of Public Health (DPH) and may be certified for Medicaid participation. Level I Screen –The first phase of the Pre-Admission Screening process. This is the initial identification and documentation (desk review) to ascertain if there is a reasonable basis to suspect a Severe Mental Illness.

Access information on quality and safety data, nurse staffing, patient satisfaction and costs of services in Illinois hospitals and surgery centers. A web-based surveillance system for hospital visits that captures information on chief complaints and diagnosis in near real-time.

Welcome to the IDPH Web Portal: From here, you can: Access IDPH Web-based applications. Requirements: To access the IDPH Web Portal, users must use Edge or Chrome browser. Some portal applications may not function properly with other browsers.

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We partner with the State of Illinois Department of Healthcare and Family Services (HFS) to manage the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) assessments for individuals applying to, or residing in, Medicaid-certified nursing facilities.