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CFS 906-4 Rev 2/2008 Illinois Department Of Children and Family Services SPECIAL SERVICE FEE AND PAYMENT EXTENSION FORM SPECIAL SERVICE FEE PAYMENT EXTENSION Client Name ID Provider Name ID Agency
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CFS 906-4 Special Service is a specific form used to report certain types of special services observed during care or treatment within a healthcare setting.
Healthcare providers and facilities that encounter special services that require documentation are required to file the CFS 906-4 Special Service.
To fill out CFS 906-4, complete all required sections including patient identification, details of the special service provided, dates of service, and relevant provider information.
The purpose of CFS 906-4 Special Service is to ensure comprehensive documentation and reporting of special services for compliance, billing, and quality assurance.
The CFS 906-4 Special Service must report patient's name, service dates, type of service, healthcare provider information, and any relevant clinical details related to the service.
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