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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:0012955II.CERTIFICATION
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Step 1: Start by gathering all the necessary information and documents needed to fill out the Good Samaritan Society application. This may include personal identification, medical records, and financial information.
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Step 2: Visit the Good Samaritan Society website or contact their office to obtain the application form. Make sure you have the most up-to-date version of the form.
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Step 3: Carefully read through the instructions provided with the application form to understand the requirements and guidelines for filling it out.
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Step 4: Begin filling out the application form by providing accurate and complete personal information, including your name, address, phone number, and date of birth.
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Step 5: Provide detailed information about your medical history, including any chronic conditions, allergies, medications, or recent surgeries.
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Step 6: If applicable, provide information about your living arrangements and any support or assistance you may require for daily activities.
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Step 7: Complete the financial information section of the application, which may include details about your income, assets, and expenses.
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Step 8: Review the completed application form to ensure all information is accurate and complete. Make any necessary corrections or additions.
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Step 9: Submit the completed application form to the Good Samaritan Society as per their instructions. This may involve mailing it to a specific address or submitting it online.
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Step 10: Follow up with the Good Samaritan Society to confirm receipt of your application and to inquire about the next steps in the process.

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The Good Samaritan Society is a non-profit organization that provides health care and social services to seniors and individuals in need of support, promoting a positive, compassionate environment.
Individuals and organizations that wish to be recognized under Good Samaritan laws or programs, typically involving volunteer services or medical assistance, are required to file.
To fill out the Good Samaritan Society forms, individuals should complete the required documentation that details their services or contributions and submit it following the guidelines provided by the organization.
The purpose of the Good Samaritan Society is to provide care and support for the vulnerable populations, ensuring they receive the necessary health care, assistance, and compassion.
The information typically includes details about the services provided, the individuals or communities served, and evidence of compliance with relevant laws and guidelines.
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