NC Innovation Forms
- Level of Care Determination (PDF, 154 KB)
- Medical Assessment (PDF, 25 KB)
- Service List (PDF, 20KB)
- Non-Use of Service Letter (PDF, 11 KB)
- Waiver Limits (PDF, 30KB)
- Freedom of Choice Form (PDF, 33KB)
- Out-of-State Travel Request (PDF, 79 KB)
- Referral Form (PDF, 155 KB)
- Risk Assessment (PDF, 649 KB)
- Risk Summary (PDF, 155 KB)
- Self-Competencies: Community Guide (PDF, 40 KB)
- Health and Safety Checklist (PDF, 107 KB)
- Unlicensed AFL Health and Safety Review Tool (Excel)
- Individual Support Plan (PDF, 467 KB)
- Update to Individual Support Plan (PDF, 102 KB)
- Back-Up Staffing Form (PDF, 83 KB)
- DSS Sample Letter (PDF, 16 KB)
- Individual Budget (Excel)
- Monitoring Checklist (Excel)
