Ruth M. Rothstein CORE Center

Cook County, IL

Official Website: https://cookcountyhealth.org/locations/ruth-m-rothstein-core-center/

Forms & Documents

Browse all Ruth M. Rothstein CORE Center government forms

1 - 20 of 25 forms

Form Title Topics
Arabic Financial Assistance Application
Computer Sign-On Form
Confidentiality Agreement Form
Cook County Health Shoppable Services – Effective January 1, 2022
Cook County Health Standard Charges – Effective January 1, 2022
English Financial Assistance Application
English Template for Short Forms
Hindi Financial Assistance Application
HIPAA Authorization Form
Infection Control Screening Compliance Form/Purple Form
Infection Control Screening Compliance Form/Purple Form
Laboratory
Mandarin Financial Assistance Application
Polish Certificate of Translation
Polish Financial Assistance Application
Polish Short Form Consent
Request for Alternative Communications
Security Access Form
Security Rules of Behavior
Spanish Certificate of Translation

Contact Information & Office Locations

1 contact point

Headquarters

Address:
2020 W. Harrison St.
Chicago, IL 60612

Phone numbers:
  • (312) 572-4500

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