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  1. IL444-2768 - ENROLLMENT/DISENROLLMENT FORM (pdf) - (R-08-17)
  2. IL444-4003 J - Responsibility and Services Plan - Mental Health Services/Job Readiness Barrier Reduction (pdf) - (R-6-12)
  3. IL444-4003 JS - Plan de Responsabilidades y Servicios - Servicios de Salud Mental / Reducción de Barreras Para Prepararse Para Empleo (pdf) - (R-6-12)
  4. IL444-4176 - MENTAL HEALTH TECHNICIAN TRAINEE (.pdf) - (R-09-18)
  5. IL444-4176 S - Técnico de Salud Mental en Entrenamiento (.pdf) - (R-09-18)
  6. IL444-4388 - Mental Health Consultant/Associate Recommendations (pdf) - (N-7-09)
  7. IL444-4401 - Pre-service/In-service Training Requirements (pdf) - (R-6-11)
  8. IL444-4401 S - Requisitos Para Capacitación Antes y Durante Servicios (pdf) - (R-6-11)
  9. IL444-4830 - Mental Health Consultant/Associate Activity Report (pdf) - (N-10-10)
  10. IL444-4830 S - Consultor de Salud Mental / Informe Actividad de Asociados (pdf) - (N-10-10)
  11. IL444-4858 - Mental Health Monthly Monitoring Checklist (pdf) - (N-10-10)
  12. IL444-4858 S - Lista Para Seguimiento Mensual de Salud Mental (pdf) - (N-10-10)
  13. IL444-4863 - Cook's Weekly Monitoring Checklist (pdf) - (N-10-10)
  14. IL444-4863 S - Lista de Verificación de Seguimiento Semanal del Cocinero (pdf) - (N-10-10)
  15. IL462-0007 - Statement of Ill. Law on Advance Directives (pdf) - (R-1-01)
  16. IL462-0007 S - DECLARACIÓN DE LA LEY EN ILLINOIS SOBRE INSTRUCCIONES ANTICIPADAS (pdf) - (R-1-01)
  17. IL462-0012 - Consent for Services (pdf) - (R-1-10)
  18. IL462-0012 A - Written Consent for HIV Antibody Testing (pdf) - (R-12-17)
  19. IL462-0012 AS - CONSENTIMIENTO ESCRITO PARA PRUEBAS DE ANTICUERPOS VIH (pdf) - (R-12-17)
  20. IL462-0012 S - CONSENTIMIENTO PARA SERVICIOS (pdf) - (R-1-10)
  21. IL462-0013 - Notice of Treatment Panel Meeting for Medication Review (pdf) - (R-1-10)
  22. IL462-0016 - Reaffirmation of Voluntary Status (pdf) - (R-06-17)
  23. IL462-0016 S - Reafirmación De Su Estado Voluntario En Un Centro Administrado Por El Estado (pdf) - (R-06-17)
  24. IL462-0019 - Request for Discharge (pdf) - (R-08-17)
  25. IL462-0019 A - Withdrawal of Request for Discharge (pdf) - (R-1-10)
  26. IL462-0019 AS - RETIRAR PETICIÓN PARA DAR DE ALTA (pdf) - (R-1-09)
  27. IL462-0019 S - Petición Para Dar de Alta (pdf) - (R-1-09)
  28. IL462-0033 - Medication Adminstration/Documentation Incident Report (pdf) - (R-7-10)
  29. IL462-0068 S - INFORMACIÓN Y PETICIÓN PARA AVISO SOBRE LIBERTAD CONDICIONAL O CUANDO SALGA EN LIBERTAD LA PERSONA (pdf) - (R-06-17)
  30. IL462-0068 - Information and Request for Notification of the Conditional Release or Discharge of a Person (pdf) - (R-06-17)
  31. IL462-0104 - OIG Training Registration Form (pdf) - (R-03-16)
  32. IL462-0105 - Biennial Facility/Agency Investigative Protocol Authorization (pdf) - (R-11-13)
  33. IL462-0131 - Basic Qualified Intellectual Disabilities Professional (QIDP) Training Program Letter of Application: Checklist B (pdf) - (R-12-16)
  34. IL462-0132 - Basic Qualified Intellectual Disabilities Professional (QIDP) Training Program Letter of Application: Checklist C (pdf) - (R-12-16)
  35. IL462-0133 - Qualified Intellectual Disabilities Professional (QIDP) Training Instructor Qualifications: Checklist D (pdf) - (R-12-16)
  36. IL462-0134 - Qualified Intellectual Disabilities Professional (QIDP) Orientation Training Core Competency Area Checklist (pdf) - (R-12-15)
  37. IL462-0135 - Qualified Intellectual Disabilities Professionals (QIDP) Training Program Course Content Review Guide (pdf) - (R-12-15)
  38. IL462-0136 - Request for Online Qualified Intellectual Disabilities Professional (QIDP) Training Program Competency Matrix (pdf) - (R-12-15)
  39. IL462-0140 - Crisis Transition Plan and Funding Request (pdf) - (R-1-13)
  40. IL462-0144 - Authorization for Use of Photography, Audio-Video Reproductions, Movies (pdf) - (R-5-04)
  41. IL462-0144 S - Autorización para el Uso de Fotografía, Reproducciones de Audio-Video, Películas (pdf) - (R-5-04)
  42. IL462-0146 - Authorization to Disclose/Obtain Information - (R-04-16)
  43. IL462-0146 A - Authorization for Release of Information and Assignment of Benefit (pdf) - (R-06-12)
  44. IL462-0146 AS - Autorización Para Revelar Información Y Traspaso de Beneficios (pdf) - (R-06-12)
  45. IL462-0146 S - Autorización Para Revelar/Obtener Información (pdf) - (R-04-16)
  46. IL462-0190 - Agreement for Use of Computer (pdf) - (R-10-07)
  47. IL462-0190 S - Acuerdo Para Usar Computadora (pdf) - (R-10-07)
  48. IL462-0202 - Contraindications for Admission to DMH Hospital (pdf) - (N-3-08)
  49. IL462-0203 - Psychiatric Medical Clearance Checklist (pdf) - (N-3-08)
  50. IL462-0220 - Individual Service & Support Advocacy (pdf) - (N-8-11)
  51. IL462-0285 - ALTERNATIVE DAY PROGRAM REQUEST (pdf) - (R-09-19)
  52. IL462-0401 - Accredition, Licensure and Certification Survey Report Form (pdf) - (N-1-02)
  53. IL462-0623 A - Authorization to Act as Payee (pdf) - (R-3-99)
  54. IL462-0623 C - Revocation of Authorization (pdf) - (R-7-02)
  55. IL462-0623 CS - REVOCACIÓN DE AUTORIZACIÓN (pdf) - (R-7-02)
  56. IL462-0623 DA - Authorization to Act as Payee (pdf) - (N-2-00)
  57. IL462-0952 - Redetermination of Medicaid DD Waiver Eligibility (pdf) - (R-1-08)
  58. IL462-0953 - CERTIFIED BEHAVIOR ANALYST - BEHAVIOR INTERVENTION and TREATMENT - LEVEL 1 CERTIFICATION VERIFICATION: CHECKLIST A (pdf) - (R-12-16)
  59. IL462-0954 - CERTIFIED BEHAVIOR ANALYST- BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 CERTIFICATION VERIFICATION: CHECKLIST B (pdf) - (R-12-16)
  60. IL462-0955 - BEHAVIOR THERAPY (Autism Spectrum Disorder) BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 APPLICATION COURSEWORK and EXPERIENCE REQUIREMENTS: CHECKLIST C (pdf) - (R-08-19)
  61. IL462-0956 - CERTIFIED RELATIONSHIP DEVELOPMENT INTERVENTION- BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 CONSULTANT CERTIFICATION VERIFICATION: CHECKLIST D (pdf) - (R-12-16)
  62. IL462-0957 - LICENSED CLINICAL PSYCHOLOGIST - BEHAVIOR INTERVENTION and TREATMENT - LEVEL 1 LICENSE VERIFICATION: CHECKLIST E (pdf) - (R-12-16)
  63. IL462-0958 - EARLY INTERVENTION SPECIALIST COURSEWORK and EXPERIENCE REQUIREMENTS: BEHAVIOR INTERVENTION and TREATMENT LEVEL 2 CHECKLIST F (pdf) - (R-12-16)
  64. IL462-1177 - Fee-for-Service Programs - Request for Payment - Billing by Provider - Event (pdf) - (N-1-08)
  65. IL462-1178 - Fee-For-Service Programs - Request for Payment Billing by Provider-Hourly (pdf) - (N-11-07)
  66. IL462-1179 - Fee-For-Service Programs - Request for Payment Billing by Provider-Per Diem (pdf) - (N-11-07)
  67. IL462-1180 - Payee Designation/Authorization Form (pdf) - (R-09-16)
  68. IL462-1201 - RIGHTS OF INDIVIDUALS (pdf) - (R-06-17)
  69. IL462-1201 S - DERECHOS DEL INDIVIDUO (Exoneración DD - Servicios de Medicaid Basados en el Hogar y en la Comunidad) (pdf) - (R-06-17)
  70. IL462-1202 - Notice of Individual's Right to Appeal Medicaid Waiver Determinations (pdf) - (R-01-17)
  71. IL462-1202 S - Aviso Sobre el Derecho de Apelación del Individuo en las Determinaciones con Exenciones del Medicaid (pdf) - (R-01-17)
  72. IL462-1209 - Staff Training Reimbursement Request for ICF/DD Facilities (pdf) - (R-7-10)
  73. IL462-1209 A - Staff Training Reimbursement Request for SNF/PED Facilities (pdf) - (R-7-10)
  74. IL462-1209 B - Staff Training Reimbursement Request for Community Providers (pdf) - (R-7-10)
  75. IL462-1214 - Release of Information (pdf) - (R-12-13)
  76. IL462-1214 S - Revelar Información (pdf) - (R-12-13)
  77. IL462-1215 - Specific Level of Functioning Assessment and Physical Health Inventory (pdf) - (R-9-08)
  78. IL462-1222 - Uniform Screening and Referral Form (pdf) - (R-09-15)
  79. IL462-1238 - Home & Community Based Services for Adults with Developmental Disabilities (Choice of Support & Services) (pdf) - (R-11-16)
  80. IL462-1238 S - Servicios Basados en Hogar y Communidad Para Individuos Con Discapacidades Del Desarrollo (pdf) - (R-11-16)
  81. IL462-1238A - Choice of Supports and Services - Ligas ICF/DD Outreach (pdf) - (N-8-13)
  82. IL462-1246 - Provider Information (pdf) - (N-2-08)
  83. IL462-1248 - Application for Individual Service Authorization (pdf) - (R-10-07)
  84. IL462-1280 - Direct Support Person (DSP) Training Program Letter of Application: Checklist G (pdf) - (R-10-16)
  85. IL462-1281 - Direct Support Person (DSP) Training Program Letter of Application: Checklist H (pdf) - (R-10-16)
  86. IL462-1282 - Direct Support Person (DSP) Training Program Instructor Qualifications: Checklist I (pdf) - (R-10-16)
  87. IL462-1283 - Direct Support Person (DSP) Training Program Two Year Review: Checklist J (pdf) - (R-10-16)
  88. IL462-1284 - Direct Support Person (DSP) Training Program Interventional Competencies Evaluation Form (pdf) - (R-10-16)
  89. IL462-1285 - Direct Support Person (DSP) Training Program Informational Competencies Evaluation Form (pdf) - (R-10-16)
  90. IL462-1286 - Direct Support Person (DSP) Training Program Core Competency Area Checklist (pdf) - (R-04-13)
  91. IL462-1287 - Direct Support Person Training Program: Classroom Competency Verification (pdf) - (N-1-12)
  92. IL462-1289 - Request for Online Direct Support Person (DSP) Training Program Competency Matrix (pdf) - (N-11-11)
  93. IL462-1290 - Direct Support Person (DSP) Training Program: Core Competency Verification (pdf) - (R-07-13)
  94. IL462-1291 - Request for Waiver of (DSP) Training Requirements (pdf) - (R-10-16)
  95. IL462-1292 - Illinois Health Care Worker Registry Application Form - Report of Direct Support (DSP) Training (pdf) - (R-03-13)
  96. IL462-1300 - Individual Profile (pdf) - (R-2-09)
  97. IL462-1301 - Adaptive Equipment/Assistive Technology/Home & Vehicle Modification Request Cover Sheet (pdf) - (R-4-09)
  98. IL462-1302 - Medicaid Waiver Therapy Prior Approval Request (pdf) - (R-12-08)
  99. IL462-1303 - Day Program Daily Attendance Record (pdf) - (N-12-07)
  100. IL462-1304 - Day Program Monthly Attendance Summary (pdf) - (N-12-07)
  101. IL462-2001 - Rights of Individuals Receiving Mental Health and Developmental Disabilities Services (pdf) - (R-06-17)
  102. IL462-2001 AD Application for Admission to an SODC (pdf) - (R-11-05)
  103. IL462-2001 D - Application for Administrative Admission to A State-Operated Center (pdf) - (R-06-17)
  104. IL462-2001 DS - Solicitud Para Admision Administrativa a Un Centro Administrado Por El Estado (pdf) - (R-06-17)
  105. IL462-2001 S - Derechos De Individuos Que Reciben Servicios De Salud Mental Y Discapacidades Del Desarrollo (pdf) - (R-06-17)
  106. IL462-2002 D - Order for Habilitation or Release (pdf) - (R-4-00)
  107. IL462-2004 D - NOTICE REGARDING RESTRICTION OF RIGHTS OF AN INDIVIDUAL (pdf) - (R-07-14)
  108. IL462-2004 M - NOTICE REGARDING RESTRICTED RIGHTS OF INDIVIDUALS (pdf) - (R-05-20)
  109. IL462-2004 MS - Aviso Sobre Derechos Restringidos Del Individuo (pdf) - (R-12-17)
  110. IL462-2005 - PETITION FOR INVOLUNTARY/JUDICIAL ADMISSION (.pdf) - (R-04-18)
  111. IL462-2005 A - Petition for Involuntary/Judicial Admission for Forensic Programs (pdf) - (R-5-08)
  112. IL462-2005 AS - PETICIÓN PARA ADMISIÓN INVOLUNTARIA / JUDICIAL PARA PROGRAMAS FORENSES (pdf) - (R-4-07)
  113. IL462-2005 S - PETICIÓN PARA ADMISIÓN INVOLUNTARIA / JUDICIAL (.pdf) - (R-04-18)
  114. IL462-2006 - Inpatient Certificate (pdf) - (R-08-13)
  115. IL462-2006 S - Certificado de Hospitalizaciónm (pdf) - (R-08-13)
  116. IL462-2007 - Writ for Detention Examination and Appearance Before Court (pdf) - (R-7-00)
  117. IL462-2008 - ORDER FOR DETENTION, EXAMINATION, DIAGNOSTIC EVALUATION (.pdf) - (R-04-19)
  118. IL462-2009 - Order for Hearing (pdf) - (R-7-00)
  119. IL462-2010 - Notice of Hearing (pdf) - (R-4-01)
  120. IL462-2010 - Notice of Hearing (pdf) - (R-04-01)
  121. IL462-2011 - Verdict of Jury (pdf) - (R-7-00)
  122. IL462-2012 - Out-Patient Certificate (pdf) - (N-3-11)
  123. IL462-2013 - Petition for Transfer (pdf) - (R-3-01)
  124. IL462-2013 S - Petición Para Traslado (pdf) - (R-3-01)
  125. IL462-2014 - Notice of Transfer Between State-Operated Centers (pdf) - (R-8-12)
  126. IL462-2014 S - Aviso Sobre Traslado Entre Centros Administrados Por El Estado (pdf) - (R-8-12)
  127. IL462-2016 - Physician's Report/Certificate (pdf) - (R-7-00)
  128. IL462-2016 S - Reporte / Certificado Del Médico (pdf) - (R-7-00)
  129. IL462-2018 - Notice of Admission (pdf) - (R-06-17)
  130. IL462-2018 S - Aviso Sobre Admision (pdf) - (R-06-17)
  131. IL462-2019 - Notice of Denial of Admission to a State-Operated Center and Right to Request Review (pdf) - (R-07-17)
  132. IL462-2019 S - Aviso De Negación Para Admisión A Un Centro Administrado Por El Estado Y Derecho A Pedir Una Revisión (pdf) - (R-07-17)
  133. IL462-2020 - Notice of Change in Status (pdf) - (R-7-00)
  134. IL462-2021 - Petition for Discharge (pdf) - (R-7-06)
  135. IL462-2022 - Notice of Discharge From a State-Operated Center (pdf) - (R-07-17)
  136. IL462-2022 S - Aviso Para Darle de Alta - Centro Administrado Por el Estado (pdf) - (R-07-17)
  137. IL462-2023 - Notice of Facility Director Decision (pdf) - (R-07-17)
  138. IL462-2023 S - Aviso Sobre Decisión Del Director De La Institución (pdf) - (R-07-17)
  139. IL462-2024 - Order for Administration of Psychotropic Medication and/or Electro-Convulsive Therapy (pdf) - (R-6-08)
  140. IL462-2025 - Petition for Administration of Psychotropic Medication/Electro Convulsive Therapy (pdf) - (R-6-08)
  141. IL462-2025 S - Petición Para Administración De Medicinas Psicotrópicas / Terapiaelectro Convulsiva (pdf) - (R-6-08)
  142. IL462-2026 - Individual/Guardian Information Form (pdf) - (N-2-08)
  143. IL462-2027 - BED HOLD EXTENSION REQUEST FORM (.pdf) - (R-05-19)
  144. IL462-2028 - SERVICE TERMINATION APPROVAL REQUEST (pdf) - (R-05-19)
  145. IL462-2028 S - PETICIÓN DE APROBACIÓN DE LA TERMINACIÓN DE SERVICIO (pdf) - (R-05-19)
  146. IL462-2029 - HOME-BASED SUPPORT SERVICES (HBS) SERVICE AGREEMENT (pdf) - (R-12-17)
  147. IL462-2029 S - ACUERDO DE SERVICIOS - SERVICIOS DE APOYO BASADO EN EL HOGAR (HBS) (pdf) - (R-12-17)
  148. IL462-2101 - Notice to Person Making a Declaration for Mental Health Treatment (pdf) - (R-5-01)
  149. IL462-2102 - Declaration for Mental Health Treatment (pdf) - (R-5-01)
  150. IL462-2202 M - Application for Voluntary Admission (pdf) - (R-10-17)
  151. IL462-2202 MS - SOLICITUD PARA ADMISIÓN VOLUNTARIA (pdf) - (R-10-17)
  152. IL462-2203 - Notice of Approval of voluntary or Informal Admission (pdf) - (R-6-12)
  153. IL462-2204 M - Outpatient Application for Minors 12 and Over (pdf) - (R-9-02)
  154. IL462-2204 MS - Solicitud Para Paciente Ambulatorio - Niños De 12 a ños Y Mayores (pdf) - (R-9-02)
  155. IL462-2205 M - Examination of Minor for Admission or Continued Hospitalization (pdf) - (R-11-02)
  156. IL462-2206 M - Application by an Adult for the Admission of a Minor to a State-Operated Center (pdf) - (R-08-17)
  157. IL462-2206 MS - Solicitud Hecha Por Un Adulto Para Admisión De Un Menor a Un Centro Administrado Por El Estado (pdf) - (R-07-17)
  158. IL462-2207 M - Petition for Review of Voluntary Admission of a Minor (pdf) - (R-9-02)
  159. IL462-2207 MS - Petición Para Revisar La Admisión Voluntaria De Un Menor (pdf) - (R-9-02)
  160. IL462-2208 M - Order for Treatment or Discharge (pdf) - (R-4-01)
  161. IL462-2210 - Pettion For Involuntary Outpatient Admission (pdf) - (R-11-12)
  162. IL462-2210 S - Petición Para Admisión Ambulatoria Involuntaria (pdf) - (R-11-12)
  163. IL462-3499 - NRI / MHSIP Inpatient Consumer Survey (pdf) - (R-5-06)
  164. IL462-3499 S - Encuesta Para Pacientes Hospitalizados En NRI/MHSIP (pdf) - (R-5-06)
  165. IL462-4000 - Clinical Transition Plan (pdf) - (N-4-11)
  166. IL462-4401 - REQUEST/APPROVAL FOR RN NURSE-TRAINER STATUS (pdf) - (R-09-17)
  167. IL462-4402 - Program Evaluation - RN Nurse - Trainer Training Program (pdf) - (N-2-10)
  168. IL462-4422 - Case Conference Summary (pdf) - (R-08-14)
  169. IL462-4422 S - RESUMEN DE LA CONFERENCIA DEL CASO (pdf) - (R-08-14)
  170. Il462-4423 - Clinical Need Summary (pdf) - (R-08-14)
  171. IL462-4423 S - RESUMEN DE NECESIDADES CLÍNICAS (pdf) - (R-08-14)
  172. IL462-4424 - Additional Staff Support and 1 or 2 Person CILA Request (pdf) - (R-08-14)
  173. IL462-4424 S - PETICIÓN PARA PERSONAL DE APOYO ADICIONAL y 1 o 2 PERSONAS CILA (pdf) - (R-08-14)
  174. IL462-4430 Authorization for Release of Information (DDPAS-7) (pdf) - (R-09-13)
  175. IL462-4454 - INDEPENDENT SERVICE COORDINATION (ISC) REVIEW AND APPROVAL OF INDIVIDUAL SERVICE PLAN (ISP) (.pdf) - (N-08-16)
  176. IL462-4454 S COORDINACIÓN DE SERVICIOS INDEPENDIENTES (ISC) REVISIÓN Y APROVACIÓN DEL PLAN INDIVIDUAL DE SERVICIOS (ISP) (pdf) - (N-08-16)
  177. IL462-5103 - Resident Medical Data Base (pdf) - (R-03-15)
  178. IL462-5105 - Cool Down Wellness Check (pdf) - (R-4-15)
  179. IL462-5200 - Visitation Request & Approval (pdf) - (R-3-15)
  180. IL462-5228 - Personal Property Receipt (pdf) - (N-6-10)
  181. IL462-5410 - Shift Preference By Seniority (pdf) - (R-8-11)
  182. IL462-5505 - Writ Receiving Authority Form (pdf) - (R-02-15)
  183. IL462-5509 MEDICAL SERVICES REFUSAL FORM (.pdf) - (N-01-19)
  184. IL462-5509 S FORMULARIO DE RECHAZO DE SERVICIOS MÉDICOS (.pdf) - (N-01-19)
  185. IL462-5618 S - LISTA DE LOS OBJETIVOS DEL TRATAMIENTO (TOC) (pdf) - (R-11-13)
  186. IL462-5900 - Medicaid Waiver Temporary Assistance (53C) Prior Approval Request (pdf)
  187. IL462-6010 - Health Care Unit Equipment (pdf) - (N-05-13)
  188. IL462-6501 - Procedures and Policies Annual Review (pdf) - (N-02-13)
  189. IL462-8152 - Interstate Services Consent for an Interstate Transfer (pdf) - (R-6-02)
  190. IL462-8152 S - Servicios Interestatalesconsentimiento Para Un Traslado Interestatal (pdf) - (R-6-02)
  191. IL462-8300 - Request for Interstate Transfer (pdf) - (R-6-05)
  192. IL462-9401 - Revocation of Authorization to Disclose Health Information (pdf) - (R-4-03)
  193. IL462-9402 - Designation or Revocation Personal Representative (pdf) - (R-4-03)
  194. IL462-9601 - Request for Amendment of Medical Record (pdf) - (R-07-17)
  195. IL462-9602 - Amendment of Medical Record (pdf) - (R-4-03)
  196. IL462-9701 - Agreement to Restrict use or Disclosure of Health Information (pdf) - (R-4-03)
  197. IL462-9702 - Request Communications by Alternative Means or Location (pdf) - (R-4-03)
  198. IL462-9909 - Facility Review Report (pdf) - (N-08-12)