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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.
704-432-5271

Provider Resource Library

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

Register here to be notified via email when new information is posted.

  
  
  
collapse Category : CAREWare ‎(1)
CAREWare Agency Agreement.pdfCAREWare Agency Agreement47 KB
collapse Category : Forms ‎(19)
2016 Federal Poverty Level.xlsx2016 Federal Poverty Level25 KB
2017 Federal Poverty Level.xlsx2017 Federal Poverty Level23 KB
CAREWare_UserAccountAgreement.pdfCAREWare_UserAccountAgreement58 KB
Case Management Assessment Form.docCase Management Assessment Form512 KB
Case Management Handbook 2016.pdfCase Management Handbook 2016747 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
EFA-ReferringAgencyChecklist.pdfEFA-ReferringAgencyChecklist1344 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 : Monitoring Tools ‎(20)
Ambulatory Care.xlsAmbulatory Care74 KB
Case Management.xlsCase Management72 KB
EIS Tool.xlsEIS Tool69 KB
Food.xlsFood71 KB
General Monitoring Report.xlsGeneral Monitoring Report95 KB
Health Insurance.xlsHealth Insurance70 KB
Housing.xlsHousing66 KB
Legal Services.xlsLegal Services68 KB
Medical Nutritional Therapy.xlsMedical Nutritional Therapy66 KB
Medications Drug Reimbursement Program.xlsMedications Drug Reimbursement Program70 KB
Mental Health.xlsMental Health83 KB
Oral Health Care.xlsOral Health Care63 KB
Outreach.xlsOutreach69 KB
Psychosocial Support.xlsPsychosocial Support71 KB
Revised Fiscal Monitoring Tool May 2018.xlsRevised Fiscal Monitoring Tool May 2018101 KB
Ryan White Fiscal Monitoring Standards.pdfRyan White Fiscal Monitoring Standards604 KB
Ryan White Program Monitoring Standard.pdfRyan White Program Monitoring Standard508 KB
Ryan White Universal Monitoring Standards.pdfRyan White Universal Monitoring Standards390 KB
Substance Abuse.xlsSubstance Abuse65 KB
Transportation - Contracted.xlsTransportation - Contracted68 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 ‎(3)
QM Plan  Revision June 2016.docxQM Plan Revision June 201691 KB
Quality Management Report.pdfQuality Management Report104 KB
Service Standards Charlotte TGA Rev Apr 2018.docxService Standards Charlotte TGA Rev Apr 2018192 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 ‎(2)
ServiceStandards-CharlotteTGA-RevMay2018.docxServiceStandards-CharlotteTGA-RevMay2018191 KB
Standard of Care - Case Management.pdfStandard of Care - Case Management331 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.
704-432-5271