Get the free NORTH CAROLINA LEVEL I SCREENING FORM - ncdhhs

This form is used for screening individuals for mental illness, mental retardation, and related conditions to determine eligibility for services in North Carolina nursing facilities.

How to fill out north carolina level i

How to fill out NORTH CAROLINA LEVEL I SCREENING FORM

1. Obtain the NORTH CAROLINA LEVEL I SCREENING FORM from the appropriate authority or website.
2. Begin with the client’s basic information: full name, date of birth, and Social Security number.
3. Fill in the client's contact information, including phone number and address.
4. Provide details about the client's living situation and any relevant family information.
5. Indicate the client's health status, including any past medical or mental health diagnoses.
6. Fill out the section on current medications, including prescribed and over-the-counter drugs.
7. Complete the questions concerning the client's history of substance use, if applicable.
8. Review the form for completeness and accuracy before submission.
9. Submit the form to the designated agency or healthcare provider.

Who needs NORTH CAROLINA LEVEL I SCREENING FORM?

1. Individuals seeking health, social, or mental health services in North Carolina.
2. Clients applying for Medicaid or other state assistance programs.
3. Healthcare providers conducting evaluations for service eligibility.
4. Family members or guardians of individuals requiring support services.

For pdfFiller’s FAQs

What is NORTH CAROLINA LEVEL I SCREENING FORM?

The NORTH CAROLINA LEVEL I SCREENING FORM is a document used to assess the eligibility and safety of prospective applicants for child care services in North Carolina.

Who is required to file NORTH CAROLINA LEVEL I SCREENING FORM?

Individuals seeking to work in or operate licensed child care facilities in North Carolina are required to file the NORTH CAROLINA LEVEL I SCREENING FORM.

How to fill out NORTH CAROLINA LEVEL I SCREENING FORM?

To fill out the NORTH CAROLINA LEVEL I SCREENING FORM, individuals must provide personal identification information, including name, address, and date of birth, and complete any additional required sections as instructed on the form.

What is the purpose of NORTH CAROLINA LEVEL I SCREENING FORM?

The purpose of the NORTH CAROLINA LEVEL I SCREENING FORM is to ensure that individuals working with children do not have a criminal history or other factors that would make them unsuitable for child care roles.

What information must be reported on NORTH CAROLINA LEVEL I SCREENING FORM?

The NORTH CAROLINA LEVEL I SCREENING FORM requires reporting of personal identification details, background history, any criminal convictions, and other relevant information as required by state regulations.