Policies, Procedures, and Forms

 

 

                         
 

     

 

POLICIES
Media Relations
 
PROCEDURES/POLICIES
Abbreviations Procedure HIM.1.10
Accounts Payable Guildlines
Access to Care
After-Care Planning with State Operated Services CST.1.27
Communication Plan
Community Resource File
Clients Rights Policy
Client and/or Concerned Citizen Complaints/Grievance Procedures AD.3.1
Client Right to an Accounting of Disclosures of ("PHI") Procedure HPRI.5.3
Dress Code
Financial Paperwork      FORMS
HIPAA Compliance Policy 8.1
Incident Reporting AD.4.1   
Information (PHI) Policy 8.9 & Information (PHI) Procedure HPRI.2.4
Maintenance Requirements for Provider Service Records
Payment for State and Federal Funded Services      FORMS
Provider Information Update Form
 
Privacy Officer Procedure HPRI.2.1
Privacy Protections Policy 8.2
Request for Information Technology Troubleshooting FS.12.12
Required Information for Authorization and Encumbrance of State and Federal Funds

Representative Payee Responsibility for Social Security (SS) and SSI
Safeguarding of Electronic Data, Financial Assets & Other Material Resources Policy 8.5
Security, Levels of Access and Limiting Disclosure and Use of Protected Health
Security, Levels of Access and Limiting Disclosure and Use of Protected Health
Security of Sensitive Information Policy 7.1
Security of Sensitive Information Procedure HIM.13.9
Status of Claims
Service Record Procedure HIM.13.4
Training Fees Procedure 9.8
Workplace Harassment
 
 
 
 
FORMS  
Admission Assessment  
Admission Assessment Addendum  
Admission Assessment Update  
Admissions Data Requirements  
ASAM Form  
Audit Provider Refund Attachment  
Audit Self-Assessment Requirements  
Audit Self-Assessment Form  
Authorization to Disclose Health Information-English  
Authorization to Disclose Health Information-Spanish  
Basic Benefits Service Plan  
Cancellation of Service Authorization Form  
CAP MR/DD Referral Packet  
Case Management Progress Note Form  
Case Transfer Form  
CDW Checklist  
Citizen Participation Form  
Client Consent Form  
Client Contact Form  
Client Rights Restriction Form  
Concerned Citizen Grievance Form  
Consent Form  
Complaint Form  
Cost Summary  
Detox Referral Form  
Developmental Disabilities Client Outcome Inventory (COI)  
Discharge Summary  
EPSDT Review Request Form 1 & Form 2  
Federal Probation Form (MH/SA Treatment Report)  
Financial Paperwork Forms  
Consumer Data Warehouse Checklist  
GAF Scale Assessment Form  
HIPAA Form-English    HIPAA Form-Spanish  
Privacy Practice Acknowledgement-English  
Maintenance Request Form  
Purchase Order Form  
Travel Advance
Travel Request
Incident Forms & Instructions
Medicaid Appeals Letter  
Division of Mental Health, Developmental Disabilities & Substance Abuse Services Hearing Request Form
NC SNAP Supplemental Information Form
NC SNAP Training Request Form
Notification of Denial of Services Letter
Notification of Suspension/Reduction Letter
OCBHS Invoice for Services
  • Providers may submit invoices weekly to the Fiscal Department for services provided.
Out of Home Community Placement for Children/Adolescents
Provider Choice Form
Provider Issue Resolution Form
Provider Quarterly Incidents Report (revised January 2006)
Qualified Provider Community Application
Reauthorization Form
Residential Risk Assessment Form
Room and Board Form Letters:
Service Authorization Form
Service Management Criteria Checklist
Referral Forms

 
Service Note Forms:
Service Order
Service Plan Form
Summary of Progress
Training Registration Form
Travel Expense Form
Treatment Plan Form
Tuberculosis Screening & Referral Form
Vendor Form (Request for Taxpayer Identification Number)
Women's Services Referral Form
Work Order Form
Work Request Form

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