WCH: Local Agencies: Children and Youth Branch Forms
Program Audit Forms
- Behavioral Health Audit Tool and Instructions (DOC, 128 KB)
- Child Health Policy Audit Tool (DOC, 109 KB)
- Newborn Visit Assessment Audit Tool and Instructions (DOCX, 58 KB)
- Pediatric Primary Care Audit Tool (DOC, 103 KB)
- Pediatric Primary Care Record Audit Tool Instructions (DOC, 72 KB)
- Well Child Care Record Audit Tool (DOC, 336 KB)
- Well Child Care Record Audit Tool Instructions (DOC, 242 KB)
Child Health Program Forms
Agreement Addenda
- 2017-2018 Child Health Agreement Addendum (PDF, 37 KB)
Clinic Forms
- DHHS 3944 Newborn Home Visit Form and Instructions (DOC, 114 KB)
- DHHS 3944 Newborn Home Visit Protocol (DOC, 106 KB)
- N.C. Child Health Program Initial History Questionnaire (English and Spanish) (PDF, 122 KB)
Clinical Growth Charts
Last Modified: October 14, 2019