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  • Dss-5209-ia. Health Summary Form - Well-visit

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Use of the OSHPD form is voluntary, but highly encouraged, as it allows hospitalsto report and the public to compare uniform information regarding common ... 7,Emergency Room Visit, Level 2 (low to.

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North Carolina has a federally mandated, state supervised, county administered social services system. This means the federal government authorizes national programs and a majority of the funding, and the state provides oversight and support. The 100 local social service agencies deliver the services and benefits.

Customers or clients may file a complaint using the NC DSS Civil Rights Complaint Form. Please fill out the form and provide a copy to the local county DSS Title VI Compliance Officer. To protect your rights you must file a complaint within 180 days of the date you believe you or someone else was treated unfairly.

Child Protective Services Requests If you are requesting information as part of an open case involving CPS, please submit the DSS-5277-ia. Requests must be submitted on your agency letterhead. A fax cover page on letterhead is acceptable.

Please Note: If you have concerns about the possible abuse or neglect of a child please contact your local county department of social services and ask for a CPS intake worker. A listing of all 100 county departments of social services may be accessed at http://.ncdhhs.gov/dss/local/.

If a social worker is either licensed (LCSW or LCSWA) or certified (CSW, CMSW, CSWM) then one may file a complaint with the North Carolina Social Work Certification and Licensure Board. The Board may be reached by calling 336-625-1679, or emailing epope@ncswboard.org.

You may file the complaint with the court by delivering it or mailing it to any of the divisional offices of the Clerk of Court. Whether you deliver or mail your complaint to the court, you must submit (1) an original of the complaint and (2) $400.00 filing fee.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232