Treatment verification 2026

1. Click ‘Get Form’ to open the treatment verification document in the editor.
2. Begin by filling out the Petitioner Information section. Enter your name, Illinois Driver’s License Number, address, sex, date of birth, and contact numbers.
3. In the Referral Source field, provide details about who referred you for treatment. Then, input your Admission and Discharge Dates for primary treatment.
4. Complete the Admission and Discharge Diagnosis sections with relevant information regarding your treatment history.
5. Select the Treatment Modality that applies to you and indicate the number of hours or days completed as required.
6. Provide a prognosis after completing treatment, discussing gains made and potential future risks.
7. Indicate your Continuing Care Status by selecting the appropriate option and providing any necessary reports.
8. Finally, fill in the Rationale section if applicable, ensuring all modifications or waivers are clearly explained.

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