| Document Title |
Description |
| 2009 Partner Survey Results |
Essential Partner Survey - Excel |
| 2009 Partner Survey Results |
Essential Partner Survey - PDF |
| 2009 Provider Survey Results |
Essential Provider Survey - Excel |
| 2009 Provider Survey Results |
Essential Provider Survey - PDF |
| 2009 Target POP's |
List of 2009 Target POPS - Excel |
| Accounting Form |
AMHC and ECBH - Excel |
| CAP Waitlist Process |
CAP Wait List Process Form |
| Critical Incident Form |
Incident Form - PDF |
| CMHC Provider Contact |
Information Sheet |
| CMHC Provider Contact & Site Info |
Provider Contact & Site Information for CMHC |
| DD Wait List |
DD Wait List Form |
| Direct Deposit Request Form |
Form to request Direct Deposit of checks -PDF |
| Dispute Resolution Form |
Form for Resolution Dispute |
| ECBH Application for Funding |
Word Document Application |
| ECBH Consent to Release |
Consent to Release PHI |
| ECBH DEIP |
Referral Form - Word |
| ECBH DEIP Application |
Application with Tax ID |
| ECBH DEIP Procedures |
Procedures for Referrals |
| EOB for Providers |
Description of EOBs |
| HIPAA Privacy Incident Reporting |
Template SAMPLE from DHHS |
| HIPAA Work Area Privacy Safeguards |
SAMPLE Assessment from DHHS |
| LME Consumer Handbook |
SAMPLE Acknowledgement |
| NCCareLINK Form |
Program Service Information |
| NCTOPPS Change QP Request Form |
Transfer NCTOPPS from Agency to Agency |
| Operations Manual |
Operations Manual ECBH - PDF File |
| Plan of Correction |
MS Word Template to be used for POC's |
| Provider DEIP Application w Tax ID |
Procedure |
| Provider UAFL |
Review Form |
| Provider Link Fax Cover Sheet |
Fax Cover Sheet for Provider Link |
| Residential Subsidy Request |
Residential Subsidy Request Form |
| Room & Board - Adult |
Establishment for Adults |
| Room & Board DSS Payment |
R&B DSS Payment Letter |
| Room & Board Parent Payment |
R&B Parent Payment Letter |
| Room & Board Provider Attestation |
R&B Request for Authorization for Payment |
| Service Management Resolution |
Resolution Request backdating 9-11-07 |
| Services Requiring NC-TOPPS |
Listing of required NC-TOPPS Services |
| STR Form |
PDF File |
| TBI Funding Request |
TBI Funding Request Form |
| Technical Assistance Request Form |
PDF File |
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