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Get Il Dah 00s-5 2009-2026
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How to fill out the IL DAH 00S-5 online
The IL DAH 00S-5 form is essential for documenting treatment verification required by the Secretary of State’s Department of Administrative Hearings. This guide provides a step-by-step approach to assist users in completing the form accurately and efficiently online.
Follow the steps to complete the IL DAH 00S-5 form with ease.
- Click ‘Get Form’ button to obtain the form and open it in the editor for online completion.
- Fill out the petitioner information section, including the petitioner’s full name, Illinois driver’s license number, address, sex, date of birth, home telephone number, and work telephone number.
- In the referral source field, enter the source that referred the petitioner for treatment.
- Enter the admission date and discharge date for the primary treatment, ensuring to exclude any follow-up or aftercare dates.
- Document the admission diagnosis and discharge diagnosis in the respective fields, or enter the TNA date and relevant diagnosis as applicable.
- Choose the treatment modality by checking the appropriate boxes and indicate the number of hours completed for outpatient or intensive outpatient counseling, or the number of days in inpatient treatment.
- Provide a prognosis after completing treatment and/or the TNA, including a rationale for the prognosis.
- Offer a clinical impression regarding the petitioner's ability to maintain a stable recovery and whether they acknowledge the severity of their alcohol/drug issues.
- List recommendations for aftercare or follow-up services, and mark the status of the follow-up.
- Provide a rationale for any changes in treatment hours or modality as indicated by the last evaluation or TNA.
- Complete the provider's information by typing or printing their name, signature, date, title, telephone number, program name, accreditation/license number, and address.
- Once all fields are completed, save any changes, download, print, or share the form as necessary.
Complete your IL DAH 00S-5 form online today to ensure timely processing of your treatment verification.
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You can visit the Illinois Secretary of State's office without an appointment for certain services. However, for specialized inquiries related to IL DAH 00S-5, it is best to check if an appointment is recommended to avoid long wait times. Generally, having an appointment ensures that you receive personalized assistance.