Follow the steps to complete the IL DAH H 68.6 form online.

1. Press the ‘Get Form’ button to access the IL DAH H 68.6 form and open it in your preferred online editor.
2. Begin by filling in the petitioner information section. Provide the name of the person (last, first, middle), their Illinois driver’s license number, and their full address (street, city, state, ZIP).
3. Next, select the sex of the petitioner and enter their date of birth.
4. Fill in the home and work telephone numbers, ensuring all formats are correct.
5. Complete the referral source field, and enter the admission and discharge dates specific to the primary treatment.
6. Provide the admission and discharge diagnoses, or the Treatment Needs Assessment (TNA) dates and related diagnoses.
7. Indicate the treatment modality by selecting the appropriate option and recording the number of hours or days as specified.
8. Provide a prognosis discussing what the petitioner has gained from treatment and the potential for future alcohol/drug-related issues.
9. Select the appropriate option regarding the continuing care status and provide any required reports.
10. Offer a rationale for any modifications in treatment hours or modalities as recommended by the last evaluation, or for any waivers.
11. Ensure that all required signatures and provider information are completed accurately.
12. Finally, save your changes, download, print, or share the completed IL DAH H 68.6 form as needed.

Complete your documents online today for a streamlined process.