We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Pdf Format - Nc Department Of Health And Human Services - Ncdhhs

Get Pdf Format - Nc Department Of Health And Human Services - Ncdhhs

On Responsible for Plan: (State Funding Only) Service Authorization By: Authorization Date: / / Person s Preferred Name: Address: City/State/Zip: Home Phone: ( )- - TYPE OF PLAN: (check all that apply) Initial Person-Centered Plan Update/Revision Date: / / Update.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the PDF format - NC Department Of Health And Human Services - Ncdhhs online

Filling out the PDF format for the NC Department Of Health And Human Services can be a straightforward process with the right guidance. This guide offers clear, step-by-step instructions to ensure you provide accurate information on your form online.

Follow the steps to successfully complete your person-centered plan.

  1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
  2. Begin with the 'Name' section, entering the individual's full name as it appears on official documents.
  3. Fill in the 'Date of Initial Plan' by entering the month, day, and year in the designated format.
  4. Provide the individual's Date of Birth (DOB) in the same format as the previous step.
  5. Enter the Medicaid ID and record number accurately to ensure proper identification.
  6. Complete the 'Person Responsible for Plan' section by noting the name of the person coordinating this plan.
  7. Indicate the type of plan by checking all applicable boxes, such as 'Initial Person-Centered Plan' or 'Update/Revision'.
  8. In the 'CONTACT PERSON(S)' section, fill out the emergency contact or next of kin's information completely.
  9. Continue filling out sections regarding involved participants, personal interviews, assessments, and crisis response strategies as required by the form.
  10. Once all sections are filled out, review your entries for accuracy and completeness.
  11. Save the completed form, download a copy for your records, and then print or share it as necessary.

Take the next step and complete your NC Department Of Health And Human Services form online today!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

DHHS Policies, Manuals and Forms
To see DHHS Policies, Manuals and Forms, please go to: https://policies.ncdhhs.gov/. Side...
Learn more
dss-5104a.pdf
NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES. DIVISION OF SOCIAL SERVICES. CHILD...
Learn more
CCNC/CA Enrollment Form
CCNC/CA Handbook provided at time of interview. ❑ CCNC/CA Handbook mailed to Case head...
Learn more

Related links form

Mo Form Cs95 Form 8810 Form 2012 K120 Fillable Garth Road Parking

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

To learn more about NC Medicaid Direct, call the NC Medicaid Contact Center at 1-888-245-0179.

Division of Health Benefits (NC Medicaid) Division of Child Development and Early Education. Division of Health Services Regulation. Division of Aging and Adult Services.

The Department of Health and Human Services manages the delivery of health- and human-related services for all North Carolinians, especially our most vulnerable people – children, elderly, disabled and low-income families.

Called "NC Medicaid Managed Care," beneficiaries choose a health plan and get care through a health plan's network of doctors. Some beneficiaries are remaining in traditional Medicaid, which is called NC Medicaid Direct.

Verify eligibility, health plan and primary care provider enrollment using the NCTracks Recipient Eligibility Verification/Response or calling the NCTracks Call Center for more information: 800-688-6696.

Non-media inquiries should be directed to 919-855-4800.

A pregnant person may be eligible if the family income is $4,218/month or less (includes one unborn child). A child ages 0-18 may be eligible if the family income is $3,595/month or less. An adult ages 19-64 may be eligible if the family income is $2,351/month or less.

It can take up to 45 days for DSS to decide if you qualify for NC Medicaid. Disability applications can take up to 90 days. We may contact you to ask for more information. Be sure your address and phone number are correct and be sure to respond to mail or phone calls from your local Department of Social Services.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get PDF Format - NC Department Of Health And Human Services - Ncdhhs
Get form
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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