Hfs 3731 Form PDF Details

The Hfs 3731 form serves as a crucial document within the State of Illinois, specifically managed by the Department of Healthcare and Family Services, focusing on the Supportive Living Program (SLP). This form is designated for the notice of involuntary discharge, marking a communication from a supportive living facility (SLF) to a resident, informing them of the termination of their residency. It comprehensively outlines the resident's name, identification number, date of birth, and the slated date of discharge, including the reasons behind such a decision. Importantly, the form also enshrines the resident's right to appeal against the discharge decision. By filing a request for a hearing with the Department within ten days after receiving this notice, residents are offered a protective measure where, during the appeal process, they cannot be discharged unless specific emergency conditions apply. The form ensures that, pending the appeal's outcome, individuals are aware of their rights and the procedural steps required to contest the SLF's decision. Moreover, it provides contact information for further assistance, underscoring the state's commitment to facilitating a fair and transparent process for those involved in involuntary discharge proceedings. Embedded within this document is the essence of ensuring residents' safety and rights, while also maintaining a structured procedural pathway for both the facilities and the residents to navigate disputes around discharge decisions.

QuestionAnswer
Form NameHfs 3731 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesSLF, Illinois, Supervising, Healthcare

Form Preview Example

State of Illinois

Department of Healthcare and Family Services

SUPPORTIVE LIVING PROGRAM

NOTICE OF INVOLUNTARY DISCHARGE

Resident Name:

Resident Identification Number:

Date of Birth:

Due to the following reason(s), you will be discharged from

 

on

 

 

 

Name of Facility

 

Date

REASON:

You have a right to appeal the supportive living facility's (SLF) decision to discharge you. You may file a request for a hearing with the Department within ten days after receiving this notice. If you request a hearing, you will not be discharged during that time unless you are unsafe to yourself or others and the SLF has given you a notice for an emergency discharge. If the SLF has not given you a notice for an emergency discharge, and if the decision following the hearing is not in your favor, you will not be discharged prior to the tenth day after receipt of the Department's hearing decision unless you are unsafe to yourself or others. If the SLF provided you with a notice of emergency discharge, and the decision following the hearing is in your favor, you will be entitled to readmission to the SLF upon the first available apartment. A form to appeal the SLF's decision and to request a hearing is attached. If you have any questions, call the Department of Healthcare and Family Services at 217/782-0545.

Name, Address and Telephone Number of Person Charged With the Responsibility of Supervising the Discharge:

(SIGNATURE OF SLF MANAGER)

(DATE)

HFS 3731 (R-9-09)

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HFS R, SIGNATURE OF SLF MANAGER, and DATE of unsafe

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