Skip to main content
Information and Resources on Hurricane Helene

For North Carolina residents and visitors affected by Hurricane Helene. Get updates and assistance

Donate to Hurricane Recovery

Please give to the North Carolina Disaster Relief Fund to help communities recover from Helene. Donate Now to the NC Disaster Relief Fund

An official website of the State of North Carolina An official website of NC How you know

State Government websites value user privacy. To learn more, view our full privacy policy.

Secure websites use HTTPS certificates. A lock icon or https:// means you’ve safely connected to the official website.

Utility Menu
  • NCDHHS COVID-19
  • NC.GOV
  • AGENCIES
  • JOBS
Home

Main menu

  • Assistance
    • Assistance
    • ADA and Civil Rights Grievance Procedure
    • Division of Aging
    • Assistive Technology
    • Children's Services
    • Deaf-Blind Services
    • Disability Services
    • Guardianship
    • Hearing Loss
    • Low-Income Services
    • Medicaid
    • Mental Health And Substance Use Disorders
    • Nondiscrimination and Accessibility Requirements
    • North Carolina Reproductive Health Services
    • Unemployment Services
    • Veteran's Services
    • Vision Loss
    • Vital Records
    • Disaster Preparation
    • Disaster Recovery Health and Safety
    • Hurricane Dorian Recovery
    • Hurricane Florence Recovery
    • Hurricane Helene Recovery Resources
  • Divisions
    • Divisions
    • Aging
    • Child and Family Well-Being
    • Child Development And Early Education
    • Disability Determination Services
    • Employment and Independence for People with Disabilities
    • Health Benefits (NC Medicaid)
    • Health Service Regulation
    • Mental Health, Developmental Disabilities, and Substance Use Services
    • Office of Economic Opportunity
    • Office of Health Equity
    • Office of Rural Health
    • Public Health
    • Services for the Blind
    • Services for the Deaf and Hard of Hearing (DSDHH)
    • Social Services
    • State Operated Healthcare Facilities
  • Providers
    • Providers
    • Licensure
    • Provider Information
    • LME-MCO Directory
    • Policies, Manuals and Forms
  • News
    • News
    • Press Releases
    • Media Contacts
    • Events
    • Newsletter Articles
  • About
    • About
    • Administrative Offices
    • Data Dashboards, Action Plans/White Papers
    • Department Initiatives
    • Directives
    • Grant Opportunities
    • Leadership
    • Overview
    • DHHS Mission, Vision, Values and Goals
    • Priority Goals
  • Contact
    • Contact
    • Division Contacts
    • Hotlines
    • Report Fraud
    • Vendor Resources

Utility Menu

  • NCDHHS COVID-19
  • NC.GOV
  • AGENCIES
  • JOBS
  1. Home
  2. Documents

Pre Admission Screening and Diversion Worksheet rev 06142019

Pre-Admission-Screening-and-Diversion-Worksheet-rev-06142019.pdf

PDF • 228.29 KB - June 24, 2019

Contact Information

NC Department of Health and Human Services
2001 Mail Service Center
Raleigh, NC 27699-2000

Customer Service Center: 1-800-662-7030
Visit RelayNC for information about TTY services.

Follow Us

Network Menu

  • Employee Directory
  • nc.gov
  • Website Feedback
  • Accessibility
  • Disclaimer & Terms of Use
  • Privacy Policy
  • Open Budget
Hosted on Digital Commons