For Local Health Departments

• Abbreviated Instructions for Staff Entering Expenditures on ATC Website (PDF, 138 KB)
• Aid to County "ATC" Change Request Form (electronic document)
• Aid to County Payment Schedule 2022 (PDF, 83 KB)
• 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, 219 KB) - Updated 02/14/22
• DPH Financial Checklist (PDF, 121 KB)
• Billing Review Tool  (PDF, 219 KB) - Updated 02/14/22
• 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 21-22 (PDF, 385 KB)
• Consolidated Agreement FY 21-22 Amendment 1 (PDF, 162 KB)
• Cover Memo: Consolidated Agreement (PDF, 335 KB)
• 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, 71 KB) - Updated 02/14/22
• Sliding Fee Scales
• Third Party
  • CAQH/ProView
• Bad Debt and DSO
  • Craven County Health Department Bad Debt Write-Off and Debt Set-Off Policy (PDF, 409 KB)
  • NC Debt Set-Off Clearinghouse
  • Sample - Review and Rebilling Denied Claims Policy (DOCX, 22 KB)
  • Warren County Health Department Debt Set-Off Policy (PDF, 56 KB)

• Administrative Consultant Training Topics (PDF, 103 KB)
• Billing Efficiency Presentation Slides (PDF, 1.4 MB)
• Finance and Billing Principles for Local Health Departments (PowerPoint Slides) (PDF, 2.4 MB)
• Lunch and Learn Leadership Series: Preparing Your Team to Serve in Disaster Shelters - 8/7/10 Recorded Training
• Lunch and Learn Leadership Series: Preparing Your Team to Serve in Disaster Shelters - 8/7/10 Slide Deck (PDF, 648 KB)
• Management and Supervision for Public Health Professionals
• What's Holding Up Your Funds? (Webinar Recording) (No CNE)

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

For DPH Consultants

• DPH Consultant Guidance - Tips for Starting Practice Management (DOCX, 177 KB)
• PM DPH and LHD Agreement (DOC, 172 KB)
• PM Implementation Plan for DPH Lead Consultant (DOCM, 22 KB)
• PM Minutes Template (DOC, 111 KB)
• PM Presentation PowerPoint (PPTX, 2.4 MB)
• PM Process Algorithm (DOCX, 24 KB)

For Local Health Departments

• Demand Tracking Tool (DOC, 48 KB)
• DPH QI PM Toolkit (DOCX, 18 KB)
• Local Health Department Readiness Assessment
• Multi-Clinic Scheduling Template (DOCX, 25 KB)
• Practice Management Clinical Workbook (XLS, 174 KB)
• Practice Management Data Dashboard CPT Code Set (XLS, 36 KB)
• Practice Management Financial Workbook (XLSX, 72 KB)
• Provider Scheduling Template: Arrival Appt Times (DOCX, 18 KB)
• Workbook for Setting Service Fees (XLS, 80 KB)

Related Resources

- Health, Self-Care, and Resiliency

- Quality Improvement and Practice Management Resource List (DOCX, 19 KB)

• Local Health Department Record Retention and Disposition Schedule

• Telemedicine and VPC: NC PHN Practice (PDF, 403 KB)

• COVID-19 Templates

  • Telehealth Medical Services COVID-19 Policy and Procedure Template - Updated 04/29/20
    • DOC, 142 KB
    • PDF, 277 KB

Subject to the availability of funds and approval of the Local Technical Assistance & Training Branch's Public Health Nursing and Professional Development Unit (PHNPDU), the LHD may request reimbursement for:

1. Nursing service personnel participating in Principles and Practices of Public Health Nursing course. Reimbursement is $400 per participant upon successful completion of the course.
2. 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)

We are currently revising the tools, templates & instructions needed to perform a CPT Clinical Record review. Please check back soon for updates.

• AMA CPT E/M Office Revisions Level of Medical Decision Making (MDM) Grid
• ACOG 2021 Evaluation and Management Summary

Documentation Guidelines

The following documents provide general principles of evaluation and management (E/M) documentation, common sets of codes used to bill for E/M services, and E/M services providers.

• Department of Health and Human Service, Centers for Medicare and Medicaid Services. Evaluation and Management Services, ICN 006764, August 2017
• 1995 Guidelines for Evaluation and Management Services
• 1997 Guidelines for Evaluation and Management Services

• NC Medical Board
• 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.

• PHN Manual Introduction
• PHN Manual What is Public Health Nursing
• PHN Manual Confidentiality
• PHN Manual Continuing Education
• PHN Manual Educational Requirements for Public Health Nurses
• PHN Manual Pharmacy
• PHN Manual Policy & Procedure Development
• PHN Manual Sample Policy & Procedure Template
• PHN Manual Policy & Procedure Practical Applications
• PHN Manual Quality Improvement & Quality Assurance
• PHN Manual Standing Orders Updated 4/7/2022

• Webinar: 2021 E/M Changes with 2022 Update
  • Link to Recording
  • Link to Handout
• Webinar: Standing Orders 1/31/2022
  • Link to Recording
  • 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. Please continue to send a copy of the attendance roster to the office PHN&PDU (publichealthnursing@dhhs.nc.gov) each time a training is offered in your agency.

• 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

NC Local Health Department Accreditation