New Patients
Downloadable Forms
Before arriving at Kids Health Partners, please download, review and complete the following forms:
Kids Health Partners Registration Form:
KHP-Registration-Form.pdf
Kids Health Partners Financial Policy:
KHP-Financial-Policy.doc
Kids Health Partners Medical Form:
KHP-Medical-Form.doc
Kids Health Partners HIPPA Form:
HIPPA.doc
Kids Health Partners Receipt of Privacy Practices Form:
Receipt-of-Privacy-Practices.doc
State of Illinois School Form:
Illinois Certificate of Child Health Examination
Hospital Affiliations
Insurance Information
Click here to view the list of accepted insurance providers.
| Aetna Open Choice PPO |
| Aetna Managed Choice POS |
| Aetna Open Access Managed Choice POS |
| Aetna QPOS |
| Aetna Elect Choice |
| Aetna Open Access Elect Choice |
| Aetna USAccess |
| Aetna National Advantage (TM) |
| Beechstreet Corporation PPO |
| Blue Cross Blue Shield HMO |
| Blue Cross Blue Shield Blue Choice |
| Blue Cross Blue Shield PPO Plus |
| Cigna Health Care POS |
| Cigna Health Care PPO |
| Evolutions Healthcare Systems PPO |
| First Health Network PPO/Workers Comp |
| GEHA (Government Employees Hospital Association) PPO |
| Great West Healthcare HMO |
| Great West Healthcare POS |
| Great West Healthcare PPO |
| HFN, Inc. (Healthcare’s Finest Network) POS |
| HFN, Inc. (Healthcare’s Finest Network) PPO |
| Humana PPO |
| Humana Freedom Plus PPO |
| Humana Freedom Plus PPO |
|
| Humana Gatekeeper PPO/Cook County |
| Humana ChoiceCare PPO |
| MCS Patient-Centered Healthcare Network PPO |
| Multiplan, Inc. |
| National Preferred Provider Network PPO |
| Preferred Network Access (PNA) PPO |
| PPONext, Inc. PPO |
| Preferred Plan, Inc. PPO |
| Principal PPO |
| Private Health Care Systems (PHCS) PPO |
| Private Health Care Systems (PHCS) Healthy Directions |
| TRICARE Standard PPO |
| Sagamore Plus PPO |
| Sagamore Select PPO |
| Unicare PPO |
| United Healthcare of Illinois HMO |
| United Healthcare of Illinois Prestige Plan HMO |
| United Healthcare of Illinois Open Access POS |
| United Healthcare of Illinois Select HMO |
| United Healthcare of Illinois Select One HMO |
| United Healthcare of Illinois Select Plus POS |
| United Healthcare of Illinois Options PPO |
| United Healthcare of Illinois Select EPO |
| United Healthcare of Illinois Choice Plus |
| USA Managed Care Organization HMO |
| USA Managed Care Organization PPO |
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