Forms

These forms are in Adobe Acrobat .pdf format. If you do not have the free Acrobat Reader on your computer, click here to get it.

 Child Medical Evaluation Program

• Brochure: This is a general information pamphlet about who we are and what we do. It should be printed in landscape (wide) duplex (front & back) format, then folded into a 3-panel (trifold) brochure.
   
• Program Guidelines: Covers examination procedures, use of forms, lab studies, photographs, case conferences, training, billing, and more (Read more about the program from the NC DSS Manual).
   
• NC Medical Consent Form (DSS #5143)
   
• CMEP Medical Report Form You have two options to submit your report for billing:
  1. Typed version - you may save a copy of the pdf template on your computer; type your responses; print the report; and mail the report to the CMEP office.
  2. Handwritten version - you may print a blank copy of the pdf template; hand write your responses; and mail the final report to the CMEP office.
  NOTE: We are not accepting electronic submissions of the CMEP report at this time.
• Case Conference Report Form (CMEP #2488)
   

Child/Family Evaluation Program

• Brochure: This is a general information pamphlet about who we are and what we do. It should be printed in landscape (wide) duplex (front & back) format, then folded into a 3-panel (trifold) brochure.
   
• Program Guidelines
   
• NC CFEP Consent Form (DSS #5143)
   
• Authorization Request for Child/Family Evaluation (Also in MS Word)
  

Do not hesitate to e-mail the CMEP office at cmep@med.unc.edu for more information.

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email: cmep@med.unc.edu