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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
 

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NC-SNAP (NC Support Needs Assessment Profile)

Forms

Assessment Profile (7/3/14)

Summary Report and Supplemental Information Coversheet (7/3/14)

An original NC-SNAP assessment form must be used to complete all NC-SNAP assessments (i.e., the NC-SNAP assessment form is copyrighted and cannot be independently reproduced).

NC-SNAP Assessment forms are available in PDF format and can be obtained by clicking the link above. The forms should not be altered in anyway. The NC SNAP maybe printed as four single pages or two pages (front and back):

page 1: background information/NC-SNAP profile
page 2: daily living supports together;
page 3: health care supports/behavior supports and
page 4: support summary together). The supplemental information sheet should be printed separately as a single page document.

All completed NC-SNAP assessments:

  • MUST be accompanied by an NC-SNAP Supplemental Information Sheet.
  • MUST be submitted to the LME/MCO for keying into the NC-SNAP data base.
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