Welcome to the North Carolina Department of Health and Human Services’ repository for manuals, policies, procedures and forms!

Welcome to the North Carolina Department of Health and Human Services’ repository for manuals, policies, procedures and forms!

DHB-5046 (3/2022) ASISTENCIA DE TRANSPORTE MÉDICO DE CAROLINA DEL NORTE AVISO DE DERECHOS/RESPONSABILIDADES Si estoy autorizado y recibo Medicaid, y no tengo medios de transporte para asistir al médico o a otros servicios médicos, Department of Social Services del condado me ayudará a obtener el transporte adecuado.

Since you moved to _______________County from _______________County, and plan to remain there on a permanent basis, we will end your assistance in ...

Welcome to the North Carolina Department of Health and Human Services’ repository for manuals, policies, procedures and forms!

Welcome to the North Carolina Department of Health and Human Services’ repository for manuals, policies, procedures and forms!

We will also need the following to process your application: Sincerely, Caseworker Signature & Date Signed Telephone Number DHB-5104 (2/2022)

Please determine whether the patient is eligible for medical assistance under Title XIX Medicaid. Use the reverse side to notify us of your decision.

VERIFICATION FORM FOR SELF-EMPLOYMENT INCOME AND EXPENSES This form is to record income and expenses for self-employment income. It is to be used only when other business or tax records are unavailable. This information is confidential and will be used only to determine your eligibility for public assistance benefits. It cannot be released without your written consent. However, the Department ...

2. You must report all changes (for example, change in income or resources, family members in the household, change of address) to your Medicaid caseworker at your local Department of Social Services within 10 days of the change. If you do not know if a change is important, ask your caseworker. DHB-5024 Revised 03/2022