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NC Division of Health Service Regulation
Adult Care Licensure Section
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Adult Care Licensure Section
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Forms and Applications
Licensure of an Adult Care or Family Care Facility
Registration of Multi-Unit Assisted Housing with Services
Resident Care Forms
Administrator Certification
Continuing Education
Medication Testing
Publication Request Form
(pdf)
Licensure of an Adult Care or Family Care Facility
Initial License Application
(PDF)
Adult Care Change Licensure Application
(PDF)
2007 Adult Care Home Renewal Application
(PDF)
Family Care Change Licensure Application
(PDF)
2007 Family Care Home Renewal Application
(PDF)
Registration of Multi-Unit Assisted Housing with Services
Disclosure Requirements
(pdf)
Resident Care Forms
DMA 3050R - Adult Care Home Personal Care Services (PCS) Physician Authorization and Plan of Care
(pdf)
Resident Register
(pdf)
Death Reporting Form
(pdf)
Resident Assessment Manual
(pdf)
Resident Assessment Memo
(pdf)
Administrator Certification
Assisted Living Administrator Certification Application
Assisted Living Administrator Certification Application
(pdf)
Family Care Home Administrator Qualifications Application
(pdf)
Administrator Certification Renewal Application
(pdf)
Administrator-In-Training (AIT) Preceptor Guidelines
Continuing Education
CE Course Guidelines
CEU Course Approval Form
(pdf)
CE Program Schedule Form
(pdf)
Medication Testing
Instructions for Completing the Registration Form
Instructions for Medication Testing
Medication Administration Checklist and Instructions
(pdf)
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Frequently Asked Questions
Medication Testing Information
Administrator Certification and Forms
Continuing Education Course Information
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Facility Licensure Information
Forms and Applications
