We are committed to honoring your rights as a patient. We want you to be an active partner in your care so you can help us meet your needs.Complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment. Specific information about disclosures and dates shall be documented in the individual's clinical record or Disclosure Tracking System. Illinois Department of Human Services Forms. Inpatient Petition; Inpatient Certificate; Outpatient Petition; Outpatient Certificate. Request Medical Records, Request Radiology Imaging, Billing Questions. Patients: call 312.996. For health care providers: Complete this form only after a conversation with the patient or the patient's representative.