Skip Ribbon Commands
Skip to main content

Address

Mailing Address:

Mecklenburg County Health Department 249 Billingsley Road Charlotte, NC 28211

Office Location:

Mecklenburg County Health Department 249 Billingsley Road Charlotte, NC 28211

Hours: 8 a.m. - 5 p.m. M - F

Contact

Health Department
704-336-4700

Provider Resource Library

Tools, forms and resources for Ryan White Provider use are available below. To be notified via email when new information is posted, click here.

  
  
  
collapse Category : CAREWare ‎(2)
CAREWare Agency Agreement.pdfCAREWare Agency Agreement47 KB
CAREWare User Agreement.pdfCAREWare User Agreement63 KB
collapse Category : Forms ‎(12)
Case Management Assessment Form.docCase Management Assessment Form512 KB
Case Management Intake Form.docCase Management Intake Form89 KB
Certified Transportation Referral Form.docCertified Transportation Referral Form201 KB
CertifiedReferralForm.docxCertifiedReferralForm28 KB
Client Eligibility Requirements.pdfClient Eligibility Requirements60 KB
Client Individualized Care Plan.docClient Individualized Care Plan41 KB
Client Level Data Certified Referral Form.xlsClient Level Data Certified Referral Form40 KB
Client Reassessment Form.pdfClient Reassessment Form196 KB
Client Rights and Responsibilities.docClient Rights and Responsibilities42 KB
Federal Poverty Level.xlsFederal Poverty Level33 KB
General Consent Form.docGeneral Consent Form42 KB
Provider General Referral Form.docProvider General Referral Form344 KB
collapse Category : Handbook ‎(1)
Case Management Handbook.pdfCase Management Handbook978 KB
collapse Category : Monitoring Tools ‎(17)
Ambulatory Care.xlsAmbulatory Care75 KB
Case Management.xlsCase Management73 KB
EIS Tool.xlsEIS Tool70 KB
Fiscal Monitoring Tool.xlsFiscal Monitoring Tool96 KB
Food.xlsFood72 KB
General Monitoring Report.xlsGeneral Monitoring Report96 KB
Health Insurance.xlsHealth Insurance71 KB
Housing.xlsHousing67 KB
Legal Services.xlsLegal Services69 KB
Medical Nutritional Therapy.xlsMedical Nutritional Therapy67 KB
Medications Drug Reimbursement Program.xlsMedications Drug Reimbursement Program69 KB
Mental Health.xlsMental Health65 KB
Oral Health Care.xlsOral Health Care64 KB
Outreach.xlsOutreach70 KB
Psychosocial Support.xlsPsychosocial Support72 KB
Substance Abuse.xlsSubstance Abuse66 KB
Transportation - Contracted.xlsTransportation - Contracted69 KB
collapse Category : Procedure/Guidance ‎(7)
2010 Transportation Procedure.pdf2010 Transportation Procedure185 KB
Dental Referrals.pdfDental Referrals461 KB
Establishing an URN.pdfEstablishing an URN67 KB
Eye Care Referral.pdfEye Care Referral231 KB
Formula for Determining Number of Files to Monitor.pdfFormula for Determining Number of Files to Monitor61 KB
Invoice-Billing Proceedure.pdfInvoice-Billing Proceedure29 KB
Undetectable Viral Loads and Visit Requirements.pdfUndetectable Viral Loads and Visit Requirements87 KB
collapse Category : Quality ‎(1)
Quality Management Report.pdf
Checked Out To: Houser, LorraineQuality Management Report.pdf
Checked Out To: Houser, LorraineQuality Management Report104 KB
collapse Category : Reports ‎(2)
MAI Quarterly Report.docMAI Quarterly Report767 KB
Part A Quarterly Report.docPart A Quarterly Report767 KB
collapse Category : Standards of Care ‎(3)
Standard of Care - Case Management.pdfStandard of Care - Case Management331 KB
Standard of Care - Food Service.pdfStandard of Care - Food Service331 KB
Standard of Care - Housing.pdfStandard of Care - Housing326 KB

 

Cannot retrieve the URL specified in the Content Link property. For more assistance, contact your site administrator.

Address

Mailing Address:

Mecklenburg County Health Department 249 Billingsley Road Charlotte, NC 28211

Office Location:

Mecklenburg County Health Department 249 Billingsley Road Charlotte, NC 28211

Hours: 8 a.m. - 5 p.m. M - F

Contact

Health Department
704-336-4700