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  1. IL444-2022 - Community Provider User ID and System Access Request (pdf) - (R-05-16)
  2. IL444-2768 - ENROLLMENT/DISENROLLMENT FORM (pdf) - (R-08-17)
  3. IL462-0007 - Statement of Ill. Law on Advance Directives (pdf) - (R-1-01)
  4. IL462-0007 S - DECLARACIÓN DE LA LEY EN ILLINOIS SOBRE INSTRUCCIONES ANTICIPADAS (pdf) - (R-1-01)
  5. IL462-0013 - Notice of Treatment Panel Meeting for Medication Review (pdf) - (R-1-10)
  6. IL462-0016 - Reaffirmation of Voluntary Status (pdf) - (R-06-17)
  7. IL462-0016 S - Reafirmación De Su Estado Voluntario En Un Centro Administrado Por El Estado (pdf) - (R-06-17)
  8. IL462-0033 - Medication Adminstration/Documentation Incident Report (pdf) - (R-7-10)
  9. IL462-0068 S - INFORMACIÓN Y PETICIÓN PARA AVISO SOBRE LIBERTAD CONDICIONAL O CUANDO SALGA EN LIBERTAD LA PERSONA (pdf) - (R-06-17)
  10. IL462-0068 - Information and Request for Notification of the Conditional Release or Discharge of a Person (pdf) - (R-06-17)
  11. IL462-0104 - OIG Training Registration Form (pdf) - (R-03-16)
  12. IL462-0130 - Qualified Intellectual Disabilities Professional (QIDP) Job & Educational Requirements: Checklist A (pdf) - (R-12-16)
  13. IL462-0131 - Basic Qualified Intellectual Disabilities Professional (QIDP) Training Program Letter of Application: Checklist B (pdf) - (R-12-16)
  14. IL462-0132 - Basic Qualified Intellectual Disabilities Professional (QIDP) Training Program Letter of Application: Checklist C (pdf) - (R-12-16)
  15. IL462-0133 - Qualified Intellectual Disabilities Professional (QIDP) Training Instructor Qualifications: Checklist D (pdf) - (R-12-16)
  16. IL462-0134 - Qualified Intellectual Disabilities Professional (QIDP) Orientation Training Core Competency Area Checklist (pdf) - (R-12-15)
  17. IL462-0135 - Qualified Intellectual Disabilities Professionals (QIDP) Training Program Course Content Review Guide (pdf) - (R-12-15)
  18. IL462-0136 - Request for Online Qualified Intellectual Disabilities Professional (QIDP) Training Program Competency Matrix (pdf) - (R-12-15)
  19. IL462-0140 - Crisis Transition Plan and Funding Request (pdf) - (R-1-13)
  20. IL462-0146 - Authorization to Disclose/Obtain Information - (R-04-16)
  21. IL462-0146 A - Authorization for Release of Information and Assignment of Benefit (pdf) - (R-06-12)
  22. IL462-0146 AS - Autorización Para Revelar Información Y Traspaso de Beneficios (pdf) - (R-06-12)
  23. IL462-0146 S - Autorización Para Revelar/Obtener Información (pdf) - (R-04-16)
  24. IL462-0159 - Instructions for LIGAS Transition Service Plan (pdf) - (R-10-14)
  25. IL462-0159 - LIGAS Transition Service Plan (pdf) - (R-10-14)
  26. IL462-0160 - LIGAS Transition Service Plan - Modified Version Instructions (pdf) - (N-07-13)
  27. IL462-0170 - Waiver Program Provider Agreement (pdf) - (N-09-15)
  28. IL462-0170 S - Waiver Program Provider Agreement (pdf) - (N-09-15)
  29. IL462-0171 - DOCUMENTATION FOR MEDICAID WAIVER APPEALS (.pdf) - (N-11-16)
  30. IL462-0290 - OTHER DAY PROGRAM REQUEST (.pdf) - (N-09-19)
  31. IL462-0401 - Accredition, Licensure and Certification Survey Report Form (pdf) - (N-1-02)
  32. IL462-0723 - PROVIDER / AGENCY / PAYEE INFORMATION UPDATE FORM (pdf) - (R-03-20)
  33. IL462-0952 - Redetermination of Medicaid DD Waiver Eligibility (pdf) - (R-1-08)
  34. IL462-0953 - CERTIFIED BEHAVIOR ANALYST - BEHAVIOR INTERVENTION and TREATMENT - LEVEL 1 CERTIFICATION VERIFICATION: CHECKLIST A (pdf) - (R-12-16)
  35. IL462-0954 - CERTIFIED BEHAVIOR ANALYST- BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 CERTIFICATION VERIFICATION: CHECKLIST B (pdf) - (R-12-16)
  36. IL462-0955 - BEHAVIOR THERAPY (Autism Spectrum Disorder) BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 APPLICATION COURSEWORK and EXPERIENCE REQUIREMENTS: CHECKLIST C (pdf) - (R-08-19)
  37. IL462-0956 - CERTIFIED RELATIONSHIP DEVELOPMENT INTERVENTION- BEHAVIOR INTERVENTION and TREATMENT - LEVEL 2 CONSULTANT CERTIFICATION VERIFICATION: CHECKLIST D (pdf) - (R-12-16)
  38. IL462-0957 - LICENSED CLINICAL PSYCHOLOGIST - BEHAVIOR INTERVENTION and TREATMENT - LEVEL 1 LICENSE VERIFICATION: CHECKLIST E (pdf) - (R-12-16)
  39. IL462-0958 - EARLY INTERVENTION SPECIALIST COURSEWORK and EXPERIENCE REQUIREMENTS: BEHAVIOR INTERVENTION and TREATMENT LEVEL 2 CHECKLIST F (pdf) - (R-12-16)
  40. IL462-1177 - Fee-for-Service Programs - Request for Payment - Billing by Provider - Event (pdf) - (N-1-08)
  41. IL462-1178 - Fee-For-Service Programs - Request for Payment Billing by Provider-Hourly (pdf) - (N-11-07)
  42. IL462-1179 - Fee-For-Service Programs - Request for Payment Billing by Provider-Per Diem (pdf) - (N-11-07)
  43. IL462-1180 - Payee Designation/Authorization Form (pdf) - (R-09-16)
  44. IL462-1201 - RIGHTS OF INDIVIDUALS (pdf) - (R-06-17)
  45. IL462-1201 S - DERECHOS DEL INDIVIDUO (Exoneración DD - Servicios de Medicaid Basados en el Hogar y en la Comunidad) (pdf) - (R-06-17)
  46. IL462-1202 - Notice of Individual's Right to Appeal Medicaid Waiver Determinations (pdf) - (R-01-17)
  47. IL462-1202 S - Aviso Sobre el Derecho de Apelación del Individuo en las Determinaciones con Exenciones del Medicaid (pdf) - (R-01-17)
  48. IL462-1203 - Determination Summary and Presentation and Selection of Service Options (DDPAS-10) (pdf) - (R-12-14)
  49. IL462-1203 S - Resumen De La Determinación, Presentación Y Selección Para Opciones De Servicios (DDPAS-10) (pdf) - (R-10-12)
  50. IL462-1209 - Staff Training Reimbursement Request for ICF/DD Facilities (pdf) - (R-7-10)
  51. IL462-1209 A - Staff Training Reimbursement Request for SNF/PED Facilities (pdf) - (R-7-10)
  52. IL462-1209 B - Staff Training Reimbursement Request for Community Providers (pdf) - (R-7-10)
  53. IL462-1209 C - STAFF TRAINING REIMBURSEMENT REQUEST FOR COMMUNITY & ICF/IDD (FACILITY) PROVIDERS FOR INSULIN AND ENTERAL TUBES (.pdf) - (R-03-19)
  54. IL462-1214 - Release of Information (pdf) - (R-12-13)
  55. IL462-1214 S - Revelar Información (pdf) - (R-12-13)
  56. IL462-1238 - Home & Community Based Services for Adults with Developmental Disabilities (Choice of Support & Services) (pdf) - (R-11-16)
  57. IL462-1238 S - Servicios Basados en Hogar y Communidad Para Individuos Con Discapacidades Del Desarrollo (pdf) - (R-11-16)
  58. IL462-1238A - Choice of Supports and Services - Ligas ICF/DD Outreach (pdf) - (N-8-13)
  59. IL462-1240 EMPLOYER OF RECORD IMPLEMENTATION STRATEGY FOR HOME BASED SUPPORTS AND SERVICES (HBS) (.pdf) - (N-01-18)
  60. IL462-1240 S - IMPLEMENTACIÓN DE ESTRATEGIA DEL EMPLEADOR DE REGISTROS PARA SERVICIOS Y APOYOS BASADO EN EL HOGAR (HBS) (dyn.pdf) - (N-01-18)
  61. IL462-1241 INSTRUCTIONS - EMPLOYER OF RECORD IMPLEMENTATION STRATEGY FOR HOME BASED SUPPORTS AND SERVICES (HBS) (.pdf) - (N-01-18)
  62. IL462-1241 S INSTRUCCIONES - IMPLEMENTACIÓN DE ESTRATEGIA DEL EMPLEADOR DE REGISTROS PARA SERVICIOS Y APOYOS BASADO EN EL HOGAR (HBS) (.pdf) - (N-01-18)
  63. IL462-1246 - Provider Information (pdf) - (N-2-08)
  64. IL462-1248 - Application for Individual Service Authorization (pdf) - (R-10-07)
  65. IL462-1280 - Direct Support Person (DSP) Training Program Letter of Application: Checklist G (pdf) - (R-10-16)
  66. IL462-1281 - Direct Support Person (DSP) Training Program Letter of Application: Checklist H (pdf) - (R-10-16)
  67. IL462-1282 - Direct Support Person (DSP) Training Program Instructor Qualifications: Checklist I (pdf) - (R-10-16)
  68. IL462-1283 - Direct Support Person (DSP) Training Program Two Year Review: Checklist J (pdf) - (R-10-16)
  69. IL462-1284 - Direct Support Person (DSP) Training Program Interventional Competencies Evaluation Form (pdf) - (R-10-16)
  70. IL462-1285 - Direct Support Person (DSP) Training Program Informational Competencies Evaluation Form (pdf) - (R-10-16)
  71. IL462-1286 - Direct Support Person (DSP) Training Program Core Competency Area Checklist (pdf) - (R-04-13)
  72. IL462-1287 - Direct Support Person Training Program: Classroom Competency Verification (pdf) - (N-1-12)
  73. IL462-1289 - Request for Online Direct Support Person (DSP) Training Program Competency Matrix (pdf) - (N-11-11)
  74. IL462-1290 - Direct Support Person (DSP) Training Program: Core Competency Verification (pdf) - (R-07-13)
  75. IL462-1291 - Request for Waiver of (DSP) Training Requirements (pdf) - (R-10-16)
  76. IL462-1292 - Illinois Health Care Worker Registry Application Form - Report of Direct Support (DSP) Training (pdf) - (R-03-13)
  77. IL462-1293 - Direct Support Person (DSP) On-The-Job Training Activities (OJT) And Accompanying Competency-Based Training Assessments (CBTA) Form (pdf) - (R-10-16)
  78. IL462-1299 SUPPORT SERVICES TEAMS REFERRAL FORM (pdf) - (R-12-19)
  79. IL462-1301 - Adaptive Equipment/Assistive Technology/Home & Vehicle Modification Request Cover Sheet (pdf) - (R-4-09)
  80. IL462-1302 - Medicaid Waiver Therapy Prior Approval Request (pdf) - (R-12-08)
  81. IL462-1303 - Day Program Daily Attendance Record (pdf) - (N-12-07)
  82. IL462-1304 - Day Program Monthly Attendance Summary (pdf) - (N-12-07)
  83. IL462-2001 - Rights of Individuals Receiving Mental Health and Developmental Disabilities Services (pdf) - (R-06-17)
  84. IL462-2001 AD Application for Admission to an SODC (pdf) - (R-11-05)
  85. IL462-2001 S - Derechos De Individuos Que Reciben Servicios De Salud Mental Y Discapacidades Del Desarrollo (pdf) - (R-06-17)
  86. IL462-2002 D - Order for Habilitation or Release (pdf) - (R-4-00)
  87. IL462-2004 D - NOTICE REGARDING RESTRICTION OF RIGHTS OF AN INDIVIDUAL (pdf) - (R-07-14)
  88. IL462-2004 M - NOTICE REGARDING RESTRICTED RIGHTS OF INDIVIDUALS (pdf) - (R-05-20)
  89. IL462-2004 MS - Aviso Sobre Derechos Restringidos Del Individuo (pdf) - (R-12-17)
  90. IL462-2008 - ORDER FOR DETENTION, EXAMINATION, DIAGNOSTIC EVALUATION (.pdf) - (R-04-19)
  91. IL462-2009 - Order for Hearing (pdf) - (R-7-00)
  92. IL462-2012 - Out-Patient Certificate (pdf) - (N-3-11)
  93. IL462-2013 - Petition for Transfer (pdf) - (R-3-01)
  94. IL462-2013 S - Petición Para Traslado (pdf) - (R-3-01)
  95. IL462-2014 - Notice of Transfer Between State-Operated Centers (pdf) - (R-8-12)
  96. IL462-2014 S - Aviso Sobre Traslado Entre Centros Administrados Por El Estado (pdf) - (R-8-12)
  97. IL462-2016 - Physician's Report/Certificate (pdf) - (R-7-00)
  98. IL462-2016 S - Reporte / Certificado Del Médico (pdf) - (R-7-00)
  99. IL462-2018 - Notice of Admission (pdf) - (R-06-17)
  100. IL462-2018 S - Aviso Sobre Admision (pdf) - (R-06-17)
  101. IL462-2019 - Notice of Denial of Admission to a State-Operated Center and Right to Request Review (pdf) - (R-07-17)
  102. 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)
  103. IL462-2020 - Notice of Change in Status (pdf) - (R-7-00)
  104. IL462-2021 - Petition for Discharge (pdf) - (R-7-06)
  105. IL462-2022 - Notice of Discharge From a State-Operated Center (pdf) - (R-07-17)
  106. IL462-2022 S - Aviso Para Darle de Alta - Centro Administrado Por el Estado (pdf) - (R-07-17)
  107. IL462-2023 - Notice of Facility Director Decision (pdf) - (R-07-17)
  108. IL462-2023 S - Aviso Sobre Decisión Del Director De La Institución (pdf) - (R-07-17)
  109. IL462-2025 - Petition for Administration of Psychotropic Medication/Electro Convulsive Therapy (pdf) - (R-6-08)
  110. IL462-2025 S - Petición Para Administración De Medicinas Psicotrópicas / Terapiaelectro Convulsiva (pdf) - (R-6-08)
  111. IL462-2026 - Individual/Guardian Information Form (pdf) - (N-2-08)
  112. IL462-2027 - BED HOLD EXTENSION REQUEST FORM (.pdf) - (R-05-19)
  113. IL462-2028 - SERVICE TERMINATION APPROVAL REQUEST (pdf) - (R-05-19)
  114. IL462-2028 S - PETICIÓN DE APROBACIÓN DE LA TERMINACIÓN DE SERVICIO (pdf) - (R-05-19)
  115. IL462-2029 - HOME-BASED SUPPORT SERVICES (HBS) SERVICE AGREEMENT (pdf) - (R-12-17)
  116. IL462-2029 S - ACUERDO DE SERVICIOS - SERVICIOS DE APOYO BASADO EN EL HOGAR (HBS) (pdf) - (R-12-17)
  117. IL462-2203 - Notice of Approval of voluntary or Informal Admission (pdf) - (R-6-12)
  118. IL462-2204 M - Outpatient Application for Minors 12 and Over (pdf) - (R-9-02)
  119. IL462-2204 MS - Solicitud Para Paciente Ambulatorio - Niños De 12 a ños Y Mayores (pdf) - (R-9-02)
  120. IL462-2205 M - Examination of Minor for Admission or Continued Hospitalization (pdf) - (R-11-02)
  121. IL462-2207 M - Petition for Review of Voluntary Admission of a Minor (pdf) - (R-9-02)
  122. IL462-2207 MS - Petición Para Revisar La Admisión Voluntaria De Un Menor (pdf) - (R-9-02)
  123. IL462-2208 M - Order for Treatment or Discharge (pdf) - (R-4-01)
  124. IL462-2210 - Pettion For Involuntary Outpatient Admission (pdf) - (R-11-12)
  125. IL462-2210 S - Petición Para Admisión Ambulatoria Involuntaria (pdf) - (R-11-12)
  126. IL462-3499 - NRI / MHSIP Inpatient Consumer Survey (pdf) - (R-5-06)
  127. IL462-3499 S - Encuesta Para Pacientes Hospitalizados En NRI/MHSIP (pdf) - (R-5-06)
  128. IL462-4000 - Clinical Transition Plan (pdf) - (N-4-11)
  129. IL462-4401 - REQUEST/APPROVAL FOR RN NURSE-TRAINER STATUS (pdf) - (R-09-17)
  130. IL462-4402 - Program Evaluation - RN Nurse - Trainer Training Program (pdf) - (N-2-10)
  131. IL462-4422 - Case Conference Summary (pdf) - (R-08-14)
  132. IL462-4422 S - RESUMEN DE LA CONFERENCIA DEL CASO (pdf) - (R-08-14)
  133. Il462-4423 - Clinical Need Summary (pdf) - (R-08-14)
  134. IL462-4423 S - RESUMEN DE NECESIDADES CLÍNICAS (pdf) - (R-08-14)
  135. IL462-4424 - Additional Staff Support and 1 or 2 Person CILA Request (pdf) - (R-08-14)
  136. IL462-4424 S - PETICIÓN PARA PERSONAL DE APOYO ADICIONAL y 1 o 2 PERSONAS CILA (pdf) - (R-08-14)
  137. IL462-4425 - Application for 60D CILA Support Services (pdf) - (R-8-14)
  138. IL462-4425 - Application for 60D CILA Support Services Instructions (pdf) - (R-9-12)
  139. IL462-4426 Prior Approval Request for Host Family Services (pdf) - (R-5-12)
  140. IL462-4427 Medication Review (DDPAS-3)(pdf) - (R-9-13)
  141. IL462-4428 - Determination Of Intellectual Disability Or Related Condition & Associated Treatment Needs (DDPAS-5) (pdf) - (R-09-13)
  142. IL462-4429 - Identification of Service Needs (DDPAS-6) (pdf) - (R-01-13)
  143. IL462-4430 Authorization for Release of Information (DDPAS-7) (pdf) - (R-09-13)
  144. IL462-4431 - Guardianship Screen (DDPAS-8) (pdf) - (N-09-13)
  145. IL462-4432 - Retirement From Active Treatment (DDPAS-9) (pdf) - (N-12-12)
  146. IL462-4434 - 24 hr Nursing Care Determination (DDPAS-4) (pdf) - (N-01-13)
  147. IL462-4435 - Intake, Assessment, & Determination Summary (DDPAS-2) (pdf) - (R-09-13)
  148. IL462-4437 - OBRA-1 Initial Screen (pdf) - (N-04-13)
  149. IL462-4437 S - OBRA-1 EVALUACIÓN INICIAL (pdf) - (N-04-13)
  150. IL462-4450 - COMMUNITY INTEGRATED LIVING ARRANGEMENT (CILA) CLOSURE CHOICE FORM (pdf) - (N-11-15)
  151. IL462-4450 S - ARREGLO DE VIVIENDA INTEGRADA EN LA COMUNIDAD (CILA) FORMULARIO PARA SELECCIÓN DURANTE CLAUSURA (.pdf) - (N-11-15)
  152. IL462-4451 Request to Exceed 25-Hour ISSA (Individual Support and Services Agency) Services Cap (pdf) - (N-11-15)
  153. IL462-4451 S - PETICIÓN PARA SOBREPASAR EL LÍMITE DE 25 HORAS DE SERVICIOS de ISSA (Apoyo Individual y Servicios de la Agencia) (.pdf) - (N-11-15)
  154. IL462-4452 - INDEPENDENT SERVICE COORDINATION (ISC) SPECIALIZED ADDITIONAL MONITORING REPORT (pdf) - (N-11-15)
  155. IL462-4452 S - INFORME DE MONITOREO ADICIONAL ESPECIALIZADO DE COORDINACIÓN DE SERVICIO INDEPENDIENTE (ISC) (.pdf) - (N-11-15)
  156. IL462-4453 - INDEPENDENT SERVICE COORDINATION/INDIVIDUAL SERVICE AND SUPPORT ADVOCACY (ISC/ISSA) TRANSFER REQUEST FORM (.pdf) - (N-07-16)
  157. IL462-4455 - DISCOVERY TOOL (dyn.pdf) - (N-11-17)
  158. IL462-4455 S - HERRAMIENTA DE DESCUBRIMIENTO (dyn.pdf) - (N-11-17)
  159. IL462-4457 - PERSONAL PLAN (.pdf) - (R-05-18)
  160. IL462-4457 S - PLAN PERSONAL (.pdf) - (R-05-18)
  161. IL462-4465 INDEPENDENT SERVICE COORDINATION (ISC) INDIVIDUAL MONITORING AND INTERVIEW NOTES (dyn.pdf) - (N-09-18)
  162. IL462-5205 INSTRUCTIONS FOR THE REQUEST FOR RESIDENTIAL SITE ID OR CHANGE TO RESIDENTIAL SITE RATE DETERMINING FACTORS FORM (.pdf) - (N-05-19)
  163. IL462-5206 REQUEST FOR RESIDENTIAL SITE ID OR CHANGE TO RESIDENTIAL SITE RATE DETERMINING FACTORS FORM (.pdf) - (N-05-19)
  164. IL462-5228 - Personal Property Receipt (pdf) - (N-6-10)
  165. IL462-5900 - Medicaid Waiver Temporary Assistance (53C) Prior Approval Request (pdf)
  166. IL462-9401 - Revocation of Authorization to Disclose Health Information (pdf) - (R-4-03)
  167. IL462-9402 - Designation or Revocation Personal Representative (pdf) - (R-4-03)
  168. IL462-9601 - Request for Amendment of Medical Record (pdf) - (R-07-17)
  169. IL462-9602 - Amendment of Medical Record (pdf) - (R-4-03)
  170. IL462-9909 - Facility Review Report (pdf) - (N-08-12)