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  1. 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.

  2. View or print a pdf of the Medical Assistance application.

  3. 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. 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. 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.

  6. 28 Ιαν 2016 · How to Fill out the Admission Applications. How_to_Fill_out_the_Admission_Applications.pdf. PDF • 7.37 KB - January 28, 2016. Contact Information. NC Department of Health and Human Services. 2001 Mail Service Center. Raleigh, NC 27699-2000. Customer Service Center: 1-800-662-7030. Visit RelayNC for information about TTY services.

  7. File Type: pdf. File Size: 494 KB. Categories: Social Services. Tags: Form. Disclaimer: The Google Translate feature (at the top right corner) of the page cannot translate all types of documents, and may not provide an exact translation. Contact Information. NC Department of Health and Human Services. 2001 Mail Service Center.

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