Get Il Annual Hospital Questionnaire 2020-2026

The IL Annual Hospital Questionnaire is a critical document mandated by the Illinois Department of Public Health. This guide provides a comprehensive, step-by-step approach to completing the questionnaire online, ensuring your submission is accurate and timely.

Follow the steps to complete the IL Annual Hospital Questionnaire with ease.

1. Press the ‘Get Form’ button to access the questionnaire. This allows you to retrieve the form and prepare it for your responses.
2. Start with Section I. In this section, you will enter general facility information including the facility’s IDPH License Number, Name, Address, City, Zip Code, and FEIN Number. Ensure that all details are accurate and reflect the current status of your facility.
3. Continue to Section II, which requires financial and capital expenditure data. Your responses should include figures from the most recent Fiscal Year available. Collect relevant documentation to ensure accuracy in reporting financials.
4. Pay special attention to the Contact and Certification fields on page 19. These fields must be completed for your submission to be accepted. Fill in the name, job title, phone number, and email of the administrator and the individual responsible for the questionnaire.
5. Review each section thoroughly, especially the detailed service categories and operational data. Ensure that numbers align with your facility's records for the specific reporting year. This includes data on admissions, outpatient visits, and any special health services your facility provides.
6. Once all fields are filled out, ensure all required sections are complete before saving your changes. After verifying all information, download or print the finalized questionnaire for your records.
7. Attach the completed PDF form in an email directed to DPH.FacilitySurvey@illinois.gov. Include 'Annual Hospital Questionnaire' in the subject line and confirm the submission before the deadline.

Complete your IL Annual Hospital Questionnaire online today to ensure compliance and avoid potential fines.