ilpsychlaw.com
Philip Pan, M.D.
ILLINOIS DEPARTMENT OF HUMAN SERVICES FORMS
Please click to the right of the title as noted to access
the Spanish language version
Main page to search for DHS forms
Authorization to Disclose / Release Information (Spanish)
Revocation of an Authorization to Disclose Health Information
Request for Amendment of Medical Records
Psychiatric Medical Clearance Checklist
Uniform Screening and Referral Form (USARF)
Application for Voluntary (inpatient) Admission (Spanish)
Request for Discharge (Spanish)
Petition for Involuntary / Judicial (inpatient) Admission (Spanish)
Certificate for Inpatient Admission (Spanish)
Examination of Minor for Admission or Continued Hospitalization
Application by an Adult for the Admission of a Minor to a State-Operated Facility (Spanish)
Petition for Involuntary Outpatient Treatment (Spanish)
Certificate for Involuntary Outpatient Treatment
Petition for Administration of Psychotropic Medications / Electroconvulsive Therapy (Spanish)
Medication counseling (Spanish)
Physician's Report / Certificate for Guardianship (Spanish)
Declaration for Mental Health Treatment
(Mental Health Treatment Preference Declarations Act form)
Additional forms that might be helpful
Illinois Department of Corrections: Authorization for Release of Offender Medical Health Information
Illinois Department of Corrections Constituent Services Division, link to Facilities Directory
Application for an Illinois Person with a Disability Identification Card
Illinois Office of the Secretary of State, Driver Services Department, Medical Report