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FOR BHF USELL1
2021STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2021)
I.DPH License ID Number:
Facility
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What is oformr specify day program?
The oformr specify day program is a form used to report specific information about a particular program or event.
Who is required to file oformr specify day program?
Any individual or organization hosting the program or event is required to file the oformr specify day program.
How to fill out oformr specify day program?
The oformr specify day program can be filled out online or submitted in person at the designated office.
What is the purpose of oformr specify day program?
The purpose of the oformr specify day program is to gather detailed information about the program or event for documentation and analysis purposes.
What information must be reported on oformr specify day program?
Information such as the name of the program, date, location, purpose, attendees, and any incident reports must be reported on the oformr specify day program.
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