Signature Requirements for Nursing Facility Level of Care Forms

In accordance with North Carolina General Statute Chapter 90-18.3, when a statute or State agency rule requires that a medical or physical examination shall be conducted by a physician, the examination may also be conducted and the form signed by a nurse practitioner or a physician assistant. A physician’s presence or co-signature is not required.

As a result, the following forms can be signed by a nurse practitioner or physician assistant:

• FL-2 Form NC Medicaid 372-124
• Physician’s Signature for Authorization of Level of Care Form DMA-0100

Contact

For any questions or concerns, contact the NC Medicaid Contact Center: 1-888-245-0179.

For any questions or concerns regarding the Nursing Facility Prior Approval Process, contact the NCTracks Helpdesk at 1-800-688-6696.