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  1. www.ncdhhs.gov › regional-referral-form-admissionsRegional Referral Form Admissions | NCDHHS

    8 Οκτ 2021 · Regional Referral Form - Admissions From DSOHF Web Site REV 10-2021_4.pdf. PDF • 192.47 KB - October 08, 2021. Contact Information. NC Department of Health and Human Services. 2001 Mail Service Center. Raleigh, NC 27699-2000.

    • Forms

      Medicaid forms required by the North Carolina Departments of...

  2. info.ncdhhs.gov › dhsr › formsappNC DHSR: Forms and Applications

    Forms and Applications. Online forms are available from various sections of the Division of Health Service Regulation. Acute and Home Care Licensure and Certification Section. Adult Care Licensure Section. Complaint Intake and Health Care Personnel Investigations Section. Construction Section.

  3. medicaid.ncdhhs.gov › applyHow To Apply for NC Medicaid

    Download and fill out a printable application to apply by: Mail, email or fax. In person (to fill out the form ahead of time) Download Printable Application (PDF) If you are a single adult with no dependents or health care coverage from your employer, use the “short form” application (DHB-5201-ia).

  4. www.nc.gov › apply-food-and-nutrition-services-food-stampsApply for Food and Nutrition Services (Food Stamps) | nc.gov

    There are three ways to apply. Apply online with ePASS. You may need to create an account first. Want to learn more about the ePASS application process? Watch this helpful video for a step-by-step overview. Apply in person at your Department of Social Services (DSS) office.

  5. medicaid.ncdhhs.gov › dma-5200-ia › openApplication for Health Coverage & Help Paying Costs - NC Medicaid

    application? • Use this application to apply for anyone in your family • Apply even if you or your child already has health coverage. You could be eligible for lower-cost or free coverage. • If you’re single, you may be able to use a short form: www.ncdhhs.gov/dma/medicaid/applications.htm • Families that include immigrants can apply.

  6. epass.nc.govNCDHHS - ePASS

    View or print a pdf of the Medical Assistance application.

  7. medicaid.ncdhhs.gov › providers › formsForms - NC Medicaid

    Medicaid forms required by the North Carolina Departments of Social Services Dental and Orthodontic Dental/orthodontic services, including prior approval, treatment extension, treatment termination and post-treatment summaries

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