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HUMAN SERVICES AGENCY SENIOR SERVICES DIVISION Daybreak Adult Day Health Care1115 East Ninth Street Post Office Box 11130 Reno, NV 895200027 Phone: 775.328.2591 Fax: 775.328.6135MEDICAL HISTORY &
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Begin by obtaining the necessary forms, which can usually be found on the NC DHHS website or by contacting a local adult day care facility.
02
Fill out the personal information section, including name, address, phone number, and emergency contacts.
03
Provide information about any medical conditions or caregiving needs that the individual may have.
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Include any preferences or special requirements that the individual may have, such as dietary restrictions or activities they enjoy.
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Review the completed form for accuracy and completeness before submitting it to the appropriate department.

Who needs nc dhhs adult day?

01
Adults who require supervision or assistance with daily activities due to physical or cognitive limitations.
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Caregivers who need respite care and support in caring for their loved ones.
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Individuals who can benefit from socialization, structured activities, and access to healthcare services.
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The North Carolina Department of Health and Human Services Adult Day Care program provides services to adults who need supervision or assistance in a safe environment during the day.
Adult day care centers in North Carolina are required to file with the NC DHHS in order to provide services to adults in need.
NC DHHS adult day care forms can be filled out online or submitted by mail. The forms include information about the center, services offered, and the individuals served.
The purpose of the NC DHHS Adult Day Care program is to provide a safe and stimulating environment for adults in need of care during the day, while also offering support to caregivers.
Information reported on the NC DHHS Adult Day Care forms includes demographics of individuals served, services provided, staffing levels, and any incidents that may have occurred.
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