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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
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Child Medical Evaluation
Community Alternatives Program Forms
Community Care of NC/Carolina ACCESS Forms
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Early and Periodic Screening, Diagnostic and Treatment Form
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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

NC Medicaid Contact Center
Phone: 888-245-0179

Census 2020

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