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FOR BHF USELL1
2007
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT FOR
LONGER CARE FACILITIES
(FISCAL YEAR 2007)I.DPH License ID Number:
Facility Name:0044289II.IMPORTANT
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To fill out the sheltered care SC, follow these steps:
02
Obtain the sheltered care SC form from the designated authority.
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Read the instructions carefully and gather all the necessary information and documents.
04
Fill in your personal details including your name, address, contact information, and social security number.
05
Provide information about your residency status and citizenship.
06
Answer the questions regarding your medical history, current health condition, and any disabilities or special needs that require sheltered care.
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If applicable, provide information about your income, assets, and any financial assistance or benefits you receive.
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Review the completed form for accuracy and completeness.
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Sign and date the form.
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Submit the form to the designated authority either in person, by mail, or online as per their instructions.
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Keep a copy of the filled-out form for your records.
Who needs sheltered care sc?
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Sheltered care SC is needed by individuals who require a supportive living environment due to their health conditions, disabilities, or special needs.
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This may include elderly individuals who need assistance with daily activities, individuals with physical or mental disabilities, or individuals recovering from surgery or illness.
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The sheltered care SC provides a safe and secure living option for individuals who may not be able to live independently but do not require intensive medical care.
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It offers assistance with daily tasks, access to medical care, social activities, and support services to improve the quality of life for those in need.
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What is sheltered care sc?
Sheltered care sc is a form used to report information about facilities that provide housing, meals, and personal care services to individuals who are unable to live independently.
Who is required to file sheltered care sc?
Facilities that provide sheltered care services are required to file sheltered care sc.
How to fill out sheltered care sc?
Sheltered care sc can be filled out by providing information about the facility, services offered, number of residents, and any other required details.
What is the purpose of sheltered care sc?
The purpose of sheltered care sc is to ensure that facilities providing sheltered care services meet the necessary standards and regulations.
What information must be reported on sheltered care sc?
Information such as facility details, services provided, number of residents, and compliance with regulations must be reported on sheltered care sc.
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