Default Page Provider License Renewal Provider Name This field is required This field needs to be a valid value If the information you will be asked to give is not truthful, disciplinary action may be taken against your license. Do you affirm that the information you are about to give or answer is true and correct? 1 = Yes 2 = No This field is required Has your name legally changed since you r most recent renewal or your initial application? 1 = Yes 2 = No This field is required Have you fully complied with the Continuing Education requirement for the renewal of your license? Note: CE is not required for the first renewal of this license. If this is your first renewal, please answer (yes) to this question 1 = Yes 2 = No This field is required Are you more than 30 days delinquent in complying with a child support order? (Note: If you are not subject to a child support order answer No.) 1 = Yes 2 = No This field is required Pursuant to Public Act 91-0244, effective January 1, 2020, if you have reason to believe that an adult 60 years of age or older who resides in a domestic living situation who, because of dysfunction is unable to seek assistance for himself or herself has, within the previous 12 months been subject to abuse, neglect or financial exploitation, the mandated reporter shall, within 24 hours after developing such belief, report this suspicion to the Department on Aging at 1-800-252-8966. Public Act 91-0244 also requires that if you have reasonable cause to believe a child known to you in your professional capacity may be an abused or neglected child you are required to report such possible neglect or abuse to the Department of Children and Family Services at 1-800-25abuse. Have you read and understood the above statements regarding child and elder abuse reporting? 1 = Yes 2 = No This field is required Are you currently charged with or have you been convicted of a criminal act that requires registration under the Sex Offender Registration Act? 1 = Yes 2 = No This field is required Are you currently charged with or have you been convicted of a criminal battery against any patient in the course of patient care or treatment, including any offense based on sexual conduct or sexual penetration? 1 = Yes 2 = No This field is required Are you required, as part of a criminal sentence, to register under the Sex Offender Registration Act? 1 = Yes 2 = No This field is required Are you currently charged with or have you been convicted of a forcible felony? 1 = Yes 2 = No This field is required Please note: Only one registration is required to prescribe controlled substances in Illinois. A separate registration is required for each place of professional practice or business where controlled substances are stored or located. Have you read and understood the above statements regarding required registration? 1 = Yes 2 = No This field is required Have you completed 3 hours of Continuing Education on safe opioid prescribing as required for the renewal of your Controlled Sub license? 1 = Yes 2 = No This field is required