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DHSR/HCPR Form No. 4500 Rev. 06/24/2014 Additional information available at www.ncnar.org Page 1 of 2 N.C. Department of Health & Human Services Division of Health Service Regulation Health Care Personnel Registry FAX: (919) 733-3207 Phone: (919) 855-3968 2719 Mail Service Center Raleigh, NC 27699-2719 5-WORKING DAY REPORT
Online forms are available from various sections of the Division of Health Service Regulation. You must have an NCID account to access the portal. you can register for a free NCID account online.
5-Working Day Report – The results of all investigations are required to be submitted within 5-working days of the initial 24-hour report whether the allegation was substantiated or not. The report should include the documentation and results of a thorough investigation.
The results of all investigations must be reported within five working days of the initial notification to the department. [see NC Gen. Stat. § 131E-256.(g)] Failure to comply may result in a report to the agency having jurisdiction for compliance enforcement.
Please see the DHHS Policies, Manuals and Forms website. Visit RelayNC for information about TTY services.
Need Help With Child Care Costs? How Do I...? Translated documents and forms were made possible by Grant Number 90TP0046-01-00 from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services.
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