Get Nc Dhhs 4142 2023-2026

This guide provides comprehensive steps to assist you in filling out the NC DHHS 4142 form online. Designed for users ranging from first-timers to those familiar with online document management, it aims to ensure a smooth and accurate submission.

Follow the steps to successfully complete the form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin filling out the participant information, including the last name, first name, middle initial, date of birth, and race. Make sure to select the appropriate options in the race section and fill in the date accurately.
3. Provide details regarding county of residence and home address. If there has been an address change, check the relevant option in the contact update log.
4. Enter the client ID number, initiation date of the form, and staff initials. Indicate the contact type by selecting the appropriate method (phone, home visit, office, etc.).
5. Indicate whether the participant is enrolled in another program by checking ‘Yes’ or ‘No’ and providing details if applicable. Confirm the listed programs to avoid duplication of services.
6. Fill in the participant's phone numbers, noting preferred contact methods. Indicate whether the participant can receive text messages.
7. Document whether interpreter services are needed and specify the preferred language for communication.
8. Complete information about the participant’s highest level of education and whether they have health insurance. If applicable, include any details about primary care providers.
9. Respond to questions regarding the participant's employment status, transportation needs, and current birth control method.
10. Detail information about the baby, including name, gender, due date, and birth weight. Include breastfeeding details and follow-up postpartum care questions.
11. Conclude by filling out screening questions regarding tobacco use, substance use, and any experiences with intimate partner violence.
12. Make sure to check the financial and housing questions to provide a complete assessment of the participant’s situation.
13. Document any coordinated support services and add any additional notes at the end of the form to ensure all relevant information is collected.
14. Once you have filled out all the necessary fields, you can save your changes, download the form, print it for your records, or share it as required.

Start filling out your documents online today to ensure timely submission and support.