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North Carolina Department of Health and Human Services Division of Aging and Adult Services Facility EvaluationIDENTIFYING INFORMATION:County Case #___ SIS 11 Digit #:___Last Name: First Name: Middle
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The North Carolina Department of Health is a state agency responsible for promoting public health, preventing disease, and ensuring access to health services.
Healthcare providers, hospitals, clinics, and other healthcare facilities are required to file with the North Carolina Department of Health.
The form can be filled out online on the North Carolina Department of Health website or submitted via mail.
The purpose of the North Carolina Department of Health is to protect and improve the health and well-being of all residents in the state.
Information such as patient demographics, diagnoses, treatments, and outcomes must be reported on the North Carolina Department of Health.
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