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FOR BHF USE LL1 2012 STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONG-TERM CARE FACILITIES (FISCAL YEAR 2012) I. DPH License ID
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How to fill out Calhoun Nursing & Rehab:

01
Begin by providing your personal information, including your full name, contact details, and date of birth.
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Fill out the medical history section, providing information about any pre-existing medical conditions, allergies, and medications you are currently taking.
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Include details about your current health status and any recent surgeries or hospitalizations.
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Provide information about your insurance coverage, including your insurance company and policy number.
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Include emergency contact information, including the name, relationship, and contact details of a trusted person who can be reached in case of an emergency.
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Sign and date the form to confirm the accuracy of the information provided.

Who needs Calhoun Nursing & Rehab:

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Individuals who require specialized medical care and rehabilitation services after a surgery or illness.
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Patients who need assistance with daily activities such as bathing, dressing, and eating.
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Elders who require long-term care and supervision due to chronic medical conditions or functional limitations.
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Individuals recovering from a stroke or other neurological conditions that require comprehensive rehabilitation services.
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Patients with complex medical conditions that can benefit from a multidisciplinary approach to care, including physical therapy, occupational therapy, and speech therapy.
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Family members who are unable to provide the necessary care and support at home for a loved one with medical needs.
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Individuals with a history of falls or mobility issues who may benefit from a safe and supportive environment.
Note: Calhoun Nursing & Rehab is a hypothetical facility used for the purpose of this example. Please refer to specific nursing and rehab centers in Calhoun or your respective area for accurate information.
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Calhoun Nursing & Rehab is a nursing home and rehabilitation facility.
The administration or management of the facility is required to file.
The form can be filled out online or submitted in person at the facility.
The purpose is to report on the status and care provided to residents.
Information on resident health, care plans, and any incidents must be reported.
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