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Community Alternatives Program Forms

Community Alternatives Program Forms

Community Alternatives Program for Children (CAP/C)

Self-Assessment Tool (DMA-3072)
Individual Risk Assessment (DMA-3073)
Service Request Form for CAP Services

Community Alternatives Program for Disabled Adults (CAP/DA)

Self-Assessment Tool (DMA-3072)
Individual Risk Assessment (DMA-3073)
Service Request Form for CAP Services

Forms

Adult Care Home and Personal Care Services Forms
Breast and Cervical Cancer Forms
Child Medical Evaluation
Community Alternatives Program Forms
Community Care of NC/Carolina ACCESS Forms
Dental and Orthodontic Forms
Durable Medical Equipment, Orthotics and Prosthetics Forms
Early and Periodic Screening, Diagnostic and Treatment Form
Hearing Loss and Auditory Processing Forms
HIV Case Management Forms
Home Health Forms
Hospice Forms
Medical Transportation Forms
Mental Health, Developmental Disabilities and Substance Abuse Forms
Nursing Facility Forms
Presumptive Eligibility Forms
Private Duty Nursing Forms
Radiology Services Form
Reproductive Health Forms
Third Party Insurance Forms
County Forms

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Contact Information

NC Medicaid
Division of Health Benefits

2501 Mail Service Center
Raleigh, NC 27699-2501

919-855-4100

Census 2020

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