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Address

Mailing Address:

Ryan White Program
618 North College Street
Charlotte, NC 28202


Office Location:

618 North College Street
Charlotte, NC 28202

MAP
Hours: Mon-Fri 8 a.m - 5 p.m.

Contact

Please do not send confidential information via email.
980-314-1606

Provider Resource Library

Tools, forms and resources for Ryan White Provider use are available below. 

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collapse Category : CAREWare ‎(2)
CAREWare Agency Agreement.pdfCAREWare Agency Agreement47 KB
CAREWare User Account Agreement 2018.pdfCAREWare User Account Agreement 201888 KB
collapse Category : Forms ‎(15)
2018 Federal Poverty Level.pdf2018 Federal Poverty Level15 KB
Case Management Assessment Form.docCase Management Assessment Form512 KB
Case Management Intake Form.docCase Management Intake Form88 KB
Case Management Service Verification.docxCase Management Service Verification28 KB
Certified Referral Form.docxCertified Referral Form38 KB
Certified Transportation Referral Form.docCertified Transportation Referral Form203 KB
Client Eligibility Requirements.pdfClient Eligibility Requirements60 KB
Client Individualized Care Plan.docClient Individualized Care Plan40 KB
Client Level Data Certified Referral Form.xlsClient Level Data Certified Referral Form40 KB
Client Reassessment Form.pdfClient Reassessment Form196 KB
Client Rights and Responsibilities.docClient Rights and Responsibilities41 KB
Eye Care Referral.pdfEye Care Referral69 KB
General Consent Form.docGeneral Consent Form41 KB
Provider General Referral Form.docProvider General Referral Form344 KB
Transportation Trip Ticket v2.docxTransportation Trip Ticket v261 KB
collapse Category : Handbook ‎(2)
Case Management Handbook 2018.pdfCase Management Handbook 20181366 KB
Charlotte TGA Resource Directory August 2018.pdfCharlotte TGA Resource Directory August 20181195 KB
collapse Category : Monitoring Tools ‎(13)
Emergency Financial Assistance Tool July 2018.xlsEmergency Financial Assistance Tool July 2018133 KB
Fiscal Tool September 2018.xlsxFiscal Tool September 201869 KB
General-Administrative Monitoring Tool July 2018.xlsGeneral-Administrative Monitoring Tool July 2018158 KB
Health Insurance Tool July 2018.xlsHealth Insurance Tool July 2018132 KB
Medical Case Management Tool July 2018.xlsMedical Case Management Tool July 2018126 KB
Medical Transportation Tool July 2018.xlsMedical Transportation Tool July 2018125 KB
Mental Health Tool July 2018.xlsMental Health Tool July 2018132 KB
Non-Medical Case Management Tool  May 2018.xlsxNon-Medical Case Management Tool May 201852 KB
Oral Health Monitoring Tool July 2018.xlsOral Health Monitoring Tool July 2018130 KB
Outpatient Ambulatory Health Services Tool Oct 2018.xlsOutpatient Ambulatory Health Services Tool Oct 2018143 KB
Psychosocial Support Tool July 2018.xlsPsychosocial Support Tool July 2018130 KB
Ryan White Fiscal Monitoring Standards.pdfRyan White Fiscal Monitoring Standards604 KB
Ryan White Program Monitoring Standard.pdfRyan White Program Monitoring Standard508 KB
collapse Category : Procedure/Guidance ‎(8)
Certified Referral Form Rev.pdfCertified Referral Form Rev91 KB
Establishing an URN.pdfEstablishing an URN67 KB
Formula for Determining Number of Files to Monitor.pdfFormula for Determining Number of Files to Monitor61 KB
Invoice-Billing Procedure.pdfInvoice-Billing Procedure29 KB
Transportation bus passes log for providers.xlsxTransportation bus passes log for providers105 KB
Transportation Referral Form for Bus Passes Services.pdfTransportation Referral Form for Bus Passes Services160 KB
Transportation Referral Form for VAN Services.pdfTransportation Referral Form for VAN Services68 KB
Undetectable Viral Loads and Visit Requirements.pdfUndetectable Viral Loads and Visit Requirements87 KB
collapse Category : Quality ‎(1)
Quality Management Plan Revision June 2018.pdfQuality Management Plan Revision June 2018952 KB
collapse Category : Reports ‎(2)
MAI Quarterly Report.docMAI Quarterly Report916 KB
Part A Quarterly Report.docPart A Quarterly Report915 KB
collapse Category : Standards of Care ‎(1)
Standards of Care May 2018.docxStandards of Care May 2018191 KB

 

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Address

Mailing Address:

Ryan White Program
618 North College Street
Charlotte, NC 28202


Office Location:

618 North College Street
Charlotte, NC 28202

MAP
Hours: Mon-Fri 8 a.m - 5 p.m.

Contact

Please do not send confidential information via email.
980-314-1606