Women, Infant and Community Wellness Section: Agreement Addenda, Audit Tools and Budget Forms
The Women, Infant and Community Wellness Section created the Agreement Addenda to guide clinical and support services through the best practices of care, as well as the legal requirements of staffing, quality and quantity of services.
The Agreement Addenda are static documents for one year. Both the current and previous fiscal year's agreement addenda and auditing tools are provided for your convenience. Information will be updated as it becomes available.
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FY 2024-2025 Agreement Addenda, Audit Tools, and Budget Forms 03/25/24
FY 2024-2025 Family Planning Agreement Addenda + Audit Tools 03/25/24
- Family Planning Agreement Addenda (PDF, 346 KB) 03/07/24
- Family Planning Agreement Addenda Audit Tools
- NC Program Review Tool (DOCX, 9 KB) 03/07/24
- Female Record (DOC, 250 KB) 03/07/24
- Male Record (DOC, 175 KB) 03/07/24
- Family Planning Outcome Objectives (OOs) by Objective Topic 2024-2025 (PDF, 733 KB) 03/25/24
- Family Planning Outcome Objectives (OOs) by County 2024-2025 (PDF, 1.4 MB) 03/25/24
- FPAR 2.0 Data Elements (PDF, 229 KB)
- Memorandum of Understanding (MOU) Family Planning Assurance Plan - Contact your Women’s Health Regional Nurse Consultant
FY 2024-2025 Maternal Health Agreement Addenda + Audit Tools 03/20/24
- Maternal Health Agreement Addenda (PDF, 382 KB) 03/13/24
- Agreement Addenda Resources (PDF, 157 KB) 03/20/24
- 3954 - Maternal Health Agreement Addenda Audit Tool (PDF, KB)
- Resources for Advancing Health Equity – August 2023 (PDF, 198 KB) 03/07/24
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, KB)
FY 2024-2025 Maternal Health Assuring Agencies + Audit Tools
- Guidelines for Local Health Departments Assuring Maternal Health Services
- Sample Assurance Plan Memorandum of Understanding
- DHHS 4150 - Agencies Assuring Maternal Health Care Audit Tool (PDF, KB)
Health Behavior Intervention Audit Tool
Health Behavior Intervention Audit Tool (DHHS 4149) (PDF, KB)
Budget Forms FY 2024-2025 - 02/28/24
- Open Window Budget Form FY 2024-2025 (XLS, 417 KB) 02/28/24
- How to Fill Out the Open Window Budget Form (DOC, 268 KB) 02/28/24
FY 2023-2024 Agreement Addenda, Audit Tools, and Budget Forms - 11/02/23
FY 2023-2024 Family Planning Agreement Addenda + Audit Tools - 11/02/23
- Family Planning Agreement Addenda (PDF, 372 KB) 09/08/23
- Family Planning Agreement Addenda Audit Tools
- NC Program Review Tool (DOCX, 98 KB) 09/08/23
- Female Record (DOC, 247 KB) 06/23 (11/02/23)
- Male Record (DOC, 178 KB) 06/23 (11/02/23)
- Family Planning Outcome Objectives (OOs) by Objective Topic 2023-2024 (PDF, 1.7 MB) 04/03/23
- Family Planning Outcome Objectives (OOs) by County 2023-2024 (PDF, 1.3 MB) 04/03/23
- FPAR 2.0 Data Elements (PDF, 229 KB) 03/07/23
- TANF Expenditure Examples/Ideas (PDF, 91 KB) 06/11/19
- Memorandum of Understanding (MOU) Family Planning Assurance Plan - Contact your Women’s Health Regional Nurse Consultant
FY 2023-2024 Maternal Health Agreement Addenda + Audit Tools - 08/17/23
- Maternal Health Agreement Addenda (PDF, 287 KB) 03/22/23
- 3954 - Maternal Health Agreement Addenda Audit Tool (PDF, 306 KB) 08/17/23
- Resources for Advancing Health Equity - March 2023 (PDF, 216 KB) 03/08/23
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, 184 KB) 03/22/23
- Maternal Health Outcome Objectives (OOs) by Objective Topic 2023-2024 (PDF, MB)
- Maternal Health Outcome Objectives (OOs) by County 2023-2024 (PDF, MB)
FY 2023-2024 Maternal Health Assuring Agencies + Audit Tools - 08/17/23
- Guidelines for Local Health Departments Assuring Maternal Health Services (PDF, 91 KB) 03/22/23
- Sample Assurance Plan Memorandum of Understanding (PDF,77 KB) 03/22/23
- DHHS 4150 - Agencies Assuring Maternal Health Care Audit Tool (PDF, 79 KB) 08/17/23
FY 2023-2024 High Risk Maternity Clinic Agreement Addenda + Audit Tools - 08/17/23
- High Risk Maternity Clinic Agreement Addenda (PDF, 263 KB) 03/22/23
- Resources for Advancing Health Equity - March 2023 (PDF, 216 KB) 03/08/23
- DHHS 4148 - High Risk Maternity Clinic Agreement Addenda Audit Tool (PDF, 314 KB) 03/08/23
Health Behavior Intervention Audit Tool - 07/05/23
Health Behavior Intervention Audit Tool (DHHS 4149) (PDF, 193 KB)
Budget Forms FY 2023-2024 03/07/23
- Open Window Budget Form FY 2023-2024 (XLS, 1 MB) 03/07/23
- How to Fill Out the Open Window Budget Form (DOC, 266 KB) 03/07/23
Last Modified: 03-25-2024