Get Nc Dhsr Mfp: Data Collection Form - Ncdhhs

Completing the NC DHSR MFP: Data Collection Form - Ncdhhs online is essential for documenting substance abuse residential services. This guide provides comprehensive, step-by-step instructions to ensure accurate and efficient completion of the form.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form, which will open in your browser for easy editing.
2. Begin by entering the contact information in Section 1. This includes the facility name and license number, street address, phone number, and details of the Chief Executive Officer or approved designee certifying the information.
3. In Section 2, indicate the relevant time period for the report. You can choose the predefined period or specify an alternative timeframe.
4. Proceed to Section 3, where you must select the licensure categories applicable to your facility. Indicate if the facility is licensed and provide the number of licensed beds for age groups 0-17 and 18 and older.
5. In Section 4, document the reimbursement source. Fill in the number of discharges and patient days of care for each age category, and indicate whether the facility is certified for Medicare or Medicaid.
6. Section 5 requires you to report days of patient care by county of patient origin. Accurately input the total days of care provided to patients from each county for both residential treatment and detox.
7. Finally, complete Section 6 by having the Chief Executive Officer or approved designee sign and date the form to certify its accuracy.
8. After filling out the form, you can save the changes, download or print it, and share it as necessary for submission.

Ensure you complete and file the NC DHSR MFP: Data Collection Form - Ncdhhs online to assist in the effective planning of substance abuse services.