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Hospital Statement of Cost BHF Page 1Healthcare and Family Services, Bureau of Health Finance, 201 S. Grand Ave. E., Springfield, IL 62763General InformationPreliminaryName of Hospital: St. Mary's

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To fill out part I-hospital, follow these steps:

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Start by providing the patient's personal information, including their name, address, and contact details.

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Next, fill in the details of the patient's insurance coverage, including policy number and type of plan.

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Enter the dates of hospital admission and discharge.

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Detail the services and procedures received during the hospital stay, along with any relevant diagnosis codes.

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What is part i-hospital?

Part i-hospital is a section of a hospital filing form that includes information about the hospital's operations, financials, and patient services.

Who is required to file part i-hospital?

All hospitals are required to file part i-hospital as part of their annual reporting requirements.

How to fill out part i-hospital?

Part i-hospital can be filled out electronically or manually, following the instructions provided in the hospital filing form.

What is the purpose of part i-hospital?

The purpose of part i-hospital is to provide transparency and accountability in the operations of hospitals, including their financials and patient services.

What information must be reported on part i-hospital?

Part i-hospital must include information about the hospital's revenue, expenses, patient admissions, and services provided.

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