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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: Northern Illinois

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Start by writing the recipient's name at the top of the form.

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Fill out the street address '4201 Medical Center Drive' on the designated line.

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Individuals who are visiting or sending mail to a specific location at 4201 Medical Center Drive.

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What is 4201 medical center drive?

4201 medical center drive is the address of a medical center.

Who is required to file 4201 medical center drive?

The medical center or the entity responsible for the address is required to file 4201 medical center drive.

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To fill out 4201 medical center drive, the required information must be provided in the designated sections of the form.

What is the purpose of 4201 medical center drive?

The purpose of 4201 medical center drive is to document and report information related to the medical center located at that address.

What information must be reported on 4201 medical center drive?

Information such as the name of the medical center, contact information, services provided, and any other relevant details must be reported on 4201 medical center drive.

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