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  • Countycare - Health Risk Screening Form Health Risk Screening Form

Get Countycare - Health Risk Screening Form Health Risk Screening Form

Health Risk Screening Please take a few minutes to fill out this form. This will help us identify any extra needs or services you may require. Please place this form in the provided postagepaid envelope.

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CountyCare offers a wide variety of resources for its members. See below for a detailed list on how to find information about your plan or covered services. Not finding what you need? Call us at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

Please notify CountyCare and give us your updated information. We can be reached at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY) and the DHS Helpline can be reached at 800-843-6154.

To learn more call CountyCare's Member Services department at: 312-864-8200 / 855-444-1661 (toll free) / 711 (TDD/TTY).

If you need help, call us at 312-864-REDE (7333). Fax: Send the completed form by fax to 1-844-736-3563. Mail: Mail the completed form to P.O. Box 19138, Springfield, IL 62763.

CountyCare offers a wide variety of resources for its members. See below for a detailed list on how to find information about your plan or covered services. Not finding what you need? Call us at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

Available to everyone enrolled in HealthChoice Illinois, CountyCare is Cook County's largest Medicaid health plan with access to more than 4,500 primary care providers, 20,000 specialists and 70 hospitals throughout Cook County.

For urgent or routine care away from home, you must get approval for CountyCare to go to an out of state or out-of-network provider. Call Member Services at 312-864-8200, 711 (TTY/TDD) to get this approval. If playback doesn't begin shortly, try restarting your device.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232