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FOR OF USELL1
2003STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
FINANCIAL AND STATISTICAL REPORT FOR
LONGER CARE FACILITIES
(FISCAL YEAR 2003)I.DPH Facility ID Number:
Facility Name:0026385II.CERTIFICATION
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Kilker-Pine Acres Group Home is a residential facility for individuals who require support and assistance with daily living activities.
Who is required to file kilker-pine acres group home?
The owner or operator of Kilker-Pine Acres Group Home is required to file the necessary documentation.
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To fill out Kilker-Pine Acres Group Home, one must provide detailed information about the residents, staff, services provided, and any incidents that may have occurred.
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Information such as resident demographics, staff qualifications, service plans, incident reports, and facility maintenance records must be reported on Kilker-Pine Acres Group Home.
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