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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/28/10

Recipient Restriction Program Primary Care Provider Authorization Form (HFS 1662)

To:​ Participating Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics, School-based Linked Health Centers, Local Health Departments and Pharmacies​
Date:​ December 28, 2010​
Re:​ Recipient Restriction Program Primary Care Provider Authorization Form (HFS 1662)​

Effective immediately, Healthcare and Family Services Office of Inspector General will no longer mail Primary Care Provider Authorization forms (HFS 1662) to primary care providers and pharmacies. The HFS 1662 (pdf) is now available on the HFS Web site, Medical Programs Forms page, to download and print.

The HFS 1662 is used by the primary care provider for referral of a Restricted Recipient Program (RRP) client to another provider for the provision of necessary services or goods which the primary care provider cannot provide to the restricted client.

Please note that this notice does not pertain to the Illinois Health Connect Medical Home Edit System requirements.

Questions regarding this notice should be directed to the Recipient Restriction Program (RRP) toll-free hotline at 1-800-325-8823. Providers experiencing problems downloading the HFS 1662 from the HFS Web site should contact the RRP hotline to request a supply of forms.

Theresa A. Eagleson, Administrator

Division of Medical Programs