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Get IL HFS Appendix S-1 2002-2023

Temporary MediPlan Card or KidCare Card. Separate the components of the name (first, middle initial, last) in the proper sections of the name field. Conditionally Required 2. Birthdate - Enter the month, day and year of birth of the participant as shown on the MediPlan Card or Temporary MediPlan Card or KidCare Card. An entry is required when charges are being billed when Form DPA 1411 does not contain a recipient number. Use the MMDDYY format. October 2002 IDPA Appendix S-1 (2) Handbook.

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