For Local Health Departments

• Abbreviated Instructions for Staff Entering Expenditures on ATC Website (PDF, 110 KB) Updated 01/09/23
• Aid to County "ATC" Change Request Form (electronic document)
• Aid to County Payment Schedule 2023 (PDF, 51 KB) - Updated 12/28/22
• Memo to LHDs re Revisions to Aid to Counties (ATC) Database and New Report (11/07/18) (PDF, 158 KB)
• Sample Time Equivalency (PDF, 367 KB)

• Current Tool (PDF, 296 KB) - Updated 08/02/23
• DPH Financial Checklist (PDF, 121 KB)
• Billing Review Tool (PDF, 112 KB) - Updated 08/02/23
• Instructions for Completing the DPH/LTAT Billing Record Review Tool (PDF, 80 KB)

• Agency Reports and Considerations for Health Directors
  • Revenue Tracking
  • Expenditure
  • Payroll
• MOE-blank

• Consolidated Agreement FY 22-23 (PDF, 465 KB)
• Cover Memo: Consolidated Agreement FY 22-23 (PDF, 396 KB)
• Consolidated Agreement FY 23-24 (PDF, 467 KB) - Added 02/09/23
• Cover Memo: Consolidated Agreement FY 23-24 (PDF, 467 KB) - Added 02/09/23
• Links to Agreement Addenda
  • Family Planning
  • Maternal Health
  • General Aid to County (PDF, 120 KB)

• Brief Form Bill or Not Bill Insurance (DOCX, 20 KB)
• Confidential Contact Explanation Card (English) (DOCX, 16 KB)
• Confidential Contact Explanation Card (Spanish) (DOCX, 24 KB)
• Income Eligibility Form (Generic) (DOCX, 40 KB)
• Registration Checklist Sample 1 (DOCX, 32 KB)
• Registration Checklist Sample 2 (DOCX, 27 KB)
• Sample Third Party Confirmation Letter (DOCX, 39 KB)
• Third Party Form (English) (DOCX, 30 KB)
• Third Party Form (Spanish) (DOCX, 32 KB)

Policies and procedures may be found under each of their respective topic headers below.

Fee Development and Fee Setting

• Fee Setting Handout (PDF, 145 KB)
• Workbook for Setting Fees (XLS, 80 KB)

Registration and Financial Eligibility

• Alias Names Policy-Sample (PDF, 98 KB)
• Approved Income Documents - Sources of Income (PDF, 214 KB)
• County Health Department Personal Data Continuation Sheet (alias names form) English (PDF, 66 KB)
• County Health Department Personal Data Continuation Sheet (alias names form) Spanish (PDF, 14 KB)
• Income Eligibility Form (DOC, 40 KB)
• Sample Checklist for Registration and Eligibility (DOCX, 22 KB)
• Terms and Conditions/Receipt of Notice of Privacy Practices (DOC, 45 KB)

Billing and Collection of Revenue

• Collecting Co-Payments and Applying Sliding Fee Scales - Job Aid for Front Desk Staff (PDF, 140 KB)
• Program Rules/Guidelines
• Sample Fee, Eligibility, and Billing Policy (DOCX, 69 KB) - Updated 09/23
• Sliding Fee Scales
• Third Party
  • CAQH/ProView
• Bad Debt and DSO
  • NC Debt Set-Off Clearinghouse
  • Sample - Review and Rebilling Denied Claims Policy (DOCX, 22 KB)

• Administrative Consultant Training Topics (PDF, 103 KB)
• Finance and Billing Principles for Local Health Departments (PowerPoint Slides) (PDF, 2.4 MB)
• Management and Supervision for Public Health Professionals

• CMS ICD-10
• Medicaid (Division of Health Benefits)
• N.C. Health Check Program Guide Revised June 2021
• Women's Health Branch
NC Medicaid Clinical Coverage Policies

• Demand Tracking Tool (DOC, 48 KB)
• Multi-Clinic Scheduling Template (DOCX, 25 KB)
• Provider Scheduling Template: Arrival Appt Times (DOCX, 18 KB)

Resources for Quality Improvement & Practice Management

• Improve Partners QI Videos & Tools
• Thinking Lean in Healthcare

• Local Health Department Record Retention and Disposition Schedule
• General Records Schedule: Local Government Agencies

Subject to the availability of funds and approval of the Local Technical Assistance & Training Branch, the LHD may request reimbursement for LHD Management/Supervision level staff participating in the Management and Supervision for Public Health Professionals course. Reimbursement is $600 per participant upon successful completion of the course.

Reimbursement requests must be submitted by the LHD to publichealthnursing@dhhs.nc.gov within the same fiscal year the course is completed.
Funds Reimbursement Request Form (Excel, 42 KB)

• Clinical Record Review Best Practices
• OCPHN Updated EM CPT Clinical Record Review Tool - Updated in September 2023
• CPT Clinical Record Review Instructions - New in June 2022
• CPT Clinical Record Review Tracking Form - New in June 2022

• Medical Record Documentation Policy Guidelines - New in December 2022
• NC Medical Board Position Statement: Medical Records
• NC Board of Nursing (NCBON) 21 NCAC 36 .0224 Components of Nursing Practice for the Registered Nurse
• NC BON Fall 2016 Bulletin, page 7, #3 - Failed to Maintain an Accurate Patient Medical Record

For DPH program forms (including POHR forms) see program websites.

• Webinar: 2021 E/M Changes with 2022 Update
  • Link to Recording
  • Link to Handout
• Webinar: Standing Orders 1/31/2022
  • Link to Handout (PDF, 1.0 MB)

PHN&PDU is no longer offering continuing education credits in association with the training. Your pharmacist may use these materials for training, but you will need to issue your own certificate of completion and maintain your own attendance and training agenda records for Accreditation and the Board of Pharmacy.

• Dispensing of Drugs by Public Health Registered Nurses Instructional Manual, updated June 2015 (PDF, 779 KB)
• Dispensing of Drugs by Public Health Registered Nurses Post Training Test, updated June 2015 (PDF, 234 KB)
• Dispensing of Drugs by Public Health Registered Nurses Training Agenda, updated June 2015 (PDF, 14 KB)
• Dispensing of Drugs by Public Health Registered Nurses Training: Part I Addendum - Naloxone Dispensing (PDF, 1.1 MB)
• Naloxone Chart: A Look at Dispensing Versus Distribution in North Carolina (PDF, 118 KB)

• Nicotine Replacement Therapy Standing Orders: Please visit QuitlineNC, Local Health Departments for standing orders related to Nicotine Replacement Therapy.
• Naloxone Standing Order:
  • Naloxone HCl Standing Order (SO) for Emergency Use in the Local Health Department (DOCX, 30 KB)
  • Adopting Naloxone Standing Orders: A Toolkit for NC Local Health Departments (PDF, 3 MB)
  • Template Standing Order for Distribution of Naloxone by Organizations (DOCX, 30 KB)
  • Template Standing Order for Dispensing Naloxone to Organizations for Subsequent Distribution (DOCX, 31 KB)

• HRSA 340b Drug Pricing Program
• APEXUS 340b Tools and Resources
• OPAIS 340b Database
• Recorded WEBINAR: Pharmacy Focus on 340B Medication with Amanda F. Moore NEW August 2023
• Pharmacy Focus on 340B handout (PDF, 2.6 MB)

NC Local Health Department Accreditation