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FOR BHF USELL1 2019STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2019) I.DPH License ID Number:
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This form is used by medical providers in Prairieview to report certain information to the Illinois Department of Healthcare and Family Services.
All medical providers in Prairieview are required to file this form.
The form can be filled out online on the www2.illinois.gov website by providing the required information.
The purpose of this form is to collect specific data from medical providers in Prairieview for regulatory and informational purposes.
Medical providers must report data related to patient care, services provided, and billing information.
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