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Address

Mailing Address:

Ryan White Program
3205 Freedom Drive, Suite 9000
Charlotte, NC 28208


Office Location:

3205 Freedom Drive, Suite 9000
Charlotte, NC 28208

MAP
Hours: Mon-Fri  8 a.m. - 5 p.m.

Contact

Please do not send confidential information
via email.


 980-314-1611

Key Initiatives

Work and Performance Plan

Provider Resource Library

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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)
2022 Federal Poverty Level.xlsx2022 Federal Poverty Level22 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.pdfCertified Referral Form95 KB
Client Eligibility Requirements.pdfClient Eligibility Requirements60 KB
Client Individualized Care Plan.docClient Individualized Care Plan40 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 Form46 KB
Provider General Referral Form.docProvider General Referral Form199 KB
Transportation Referral Form for Bus Passes Services.pdfTransportation Referral Form for Bus Passes Services91 KB
Transportation Referral Form for VAN Services.pdfTransportation Referral Form for VAN Services69 KB
Transportation Trip Ticket v2.docxTransportation Trip Ticket v261 KB
collapse Category : Handbook ‎(1)
Case Management Handbook 2018.pdfCase Management Handbook 20181366 KB
collapse Category : Monitoring Tools ‎(12)
Emergency Financial Assistance Tool July 2018.xlsEmergency Financial Assistance Tool July 2018133 KB
Fiscal Tool April 2019.xlsxFiscal Tool April 201968 KB
General-Administrative Tool April 2019.xlsGeneral-Administrative Tool April 2019161 KB
Health Insurance Tool July 2018.xlsHealth Insurance Tool July 2018132 KB
Medical Case Management Tool.xlsMedical Case Management Tool125 KB
Medical Transportation Tool July 2018.xlsMedical Transportation Tool July 2018125 KB
Mental Health Tool July 2018.xlsMental Health Tool July 2018132 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 ‎(6)
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
Medical Transportation Policies and Procedures.pdfMedical Transportation Policies and Procedures557 KB
Transportation bus passes log for providers.xlsxTransportation bus passes log for providers105 KB
Undetectable Viral Loads and Visit Requirements.pdfUndetectable Viral Loads and Visit Requirements87 KB
collapse Category : Quality ‎(1)
QM Plan Revision June 2020.pdfQM Plan Revision June 2020164 KB
collapse Category : Reports ‎(2)
MAI Quarterly Report.docMAI Quarterly Report768 KB
Part A Quarterly Report.docPart A Quarterly Report767 KB
collapse Category : Standards of Care ‎(1)
Service Standards FY 2020-2021.pdfService Standards FY 2020-2021479 KB

 

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Address

Mailing Address:

Ryan White Program
3205 Freedom Drive, Suite 9000
Charlotte, NC 28208


Office Location:

3205 Freedom Drive, Suite 9000
Charlotte, NC 28208

MAP
Hours: Mon-Fri  8 a.m. - 5 p.m.

Contact

Please do not send confidential information
via email.


 980-314-1611

Key Initiatives

Work and Performance Plan