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FOR BHF USELL1
2011
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2011)I.DPH License ID Number:
Facility
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01
Obtain the PHEN 601 Introduction to form from the relevant department.
02
Fill in your personal information such as name, student ID number, and contact details.
03
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04
List any prerequisites or co-requisites that you have completed or are currently enrolled in.
05
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06
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