Get Alton Mem Hsp Hatch Sk N W-2003-8000267.pdf - State Of Illinois - Www2 Illinois

Filling out the Alton Memorial Hospital Hatch Sk N W-2003-8000267 form can seem daunting, but with clear instructions, it can be manageable. This guide provides step-by-step assistance to help ensure accurate and efficient completion of the document.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to access the document and begin filling it out.
2. Enter the IDPH facility ID number and the name of the facility at the top of the form. Ensure the facility name is correctly spelled to avoid confusion.
3. Fill out the certification section, including the authorized facility officer's details. This includes their name, title, contact information, and the date of the initial license.
4. Provide the address information including the street, city, state, zip code, and county. Ensure all information is accurate to avoid delays in processing.
5. Complete the statistical data section carefully. Enter the number of beds at the beginning and end of the report period, along with the total licensed bed days.
6. List the census data for the report period. This includes the number of patient days and the primary sources of payment.
7. Fill in the cost center expenses section. Report all costs related to general services, health care programs, and general administration.
8. Complete the ownership costs section, detailing any depreciation and land costs associated with the facility.
9. Review all entered information thoroughly for accuracy before you finalize the form.
10. After ensuring all sections are complete, save changes, download, and share the form as required.

Start filling out your document online today to ensure timely and accurate submission.