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Click ‘Get Form’ to open the IDHS document in the editor.
Begin by reviewing your Service Plan, which outlines the services you are eligible to receive. This will guide your hiring process.
Fill in your personal information at the top of the form, ensuring accuracy for timely processing.
In the section regarding Providers, list potential candidates and their qualifications based on your needs outlined in the Service Plan.
Complete the Time Sheet section accurately, noting hours worked and tasks performed by each Provider. Ensure both you and your Provider sign this section.
Review all entries for completeness before submitting. Use our platform's features to save and share the completed form easily.
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HFS administers Medicaid under the Illinois Public Aid Code. Through an inter-agency agreement with HFS, the Illinois Department of Human Services (DHS).
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