Get And Sign Illinois Court Of Claims Illinois Secretary Of State 2016-2021 Form

Name Provider Reference PR No. assigned by Provider Dates of Service DOS Patient Name Provider Billings IDPA Responses Patient Date of Birth DOB PR IDPA Recipient No. RIN DOS Amount Billed to IDPA IDPA Case Name/Case No. attached statement and made a part thereof as Exhibit A. 1 5 ILCS 315/1 et seq. 2 705 ILCS 505/1 et seq. Text of Section from P. A. 93-414 Sec. 1. Except as provided in the Illinois Public Labor Relations Act the Court of Claims Act or Section 1. 18 505/28 Application.. 18...