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Sampling Zone Collect Week Routine Monitoring Sample Sites Repeat Monitoring Samples Sites within 5 service connections 1 Upstream 2 Downstream 1A1 1A2 1A 1A1 1A2 1B 1B1 1B2 1C1 1C2 1D1 1D2 2A1 2A2 2B1 2B2 2C1 2C2 2D1 2D2 3A1 3A2 3B1 3B2 3C1 3C2 3D1 3D2 1C 1D 1E 2A 2B 2C 2D 2E 3A 3B 3C 3D 3E PHA-53 50503 3/16 4A 4B 4C 4D 4E 5A 5B 5C 5D 5E 6A 6B 6C 6D 6E 7A 7B 7C 7D 7E 8A 8B 8C 8D 8E 4A1 4A2 4B1 4B2 4C1 4C2 4D1 4D2 5A1 5A2 5B1 5B2 5C1 5C2 5D1 5D2 6A1 6A2 6B1 6B2 6C1 6C2 6D1 6D2 7A1 7A2 7B1 7B2...
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01
Get a copy of the DHHS Division of Public form from their website or office.
02
Read the instructions carefully before filling out the form.
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Start by filling out the personal information section, including your full name, address, and contact details.
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Next, provide the necessary details about your current employment or source of income.
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If applicable, provide information about your spouse or dependents.
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Fill out the sections related to your healthcare coverage, including any existing insurance plans.
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Submit the completed form to the DHHS Division of Public through their designated channels.
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Wait for a response from DHHS regarding the status of your application.
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What is dhhs division of public?
The Division of Public Health is responsible for protecting and improving the health of the population in North Carolina.
Who is required to file dhhs division of public?
Healthcare facilities, providers, and organizations in North Carolina are required to file reports with the Division of Public Health.
How to fill out dhhs division of public?
The DHHS Division of Public Health provides online forms and guidance for healthcare entities to properly fill out and submit their reports.
What is the purpose of dhhs division of public?
The purpose of the DHHS Division of Public Health is to monitor and address public health issues in the state, and to ensure the well-being of North Carolina communities.
What information must be reported on dhhs division of public?
Healthcare facilities need to report data on patient demographics, diagnoses, treatments, and outcomes to the Division of Public Health.
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