DHHS: DPH: WICWS: 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.

[+] Expand All Items | [-] Collapse All Items

FY 2025-2026 Agreement Addenda, Audit Tools, and Budget Forms

FY 2025-2026 Family Planning Agreement Addenda + Audit Tools

Family Planning Agreement Addenda (PDF, 371 KB) 02/10/25
Family Planning Agreement Addenda Audit Tools
- NC Program Review Tool (DOCX, KB)
- emale Record (DOC, KB)
- Male Record (DOC, KB)
Family Planning Outcome Objectives (OOs) by Objective Topic 2025-2026 (PDF, MB)
Family Planning Outcome Objectives (OOs) by County 2025-2026 (PDF, MB)
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 2025-2026 Maternal Health Agreement Addenda + Audit Tools

Maternal Health Agreement Addenda (PDF, 382 KB) 02/10/25
3954 - Maternal Health Agreement Addenda Audit Tool (PDF, KB)
Resources for Advancing Health Equity
DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, KB)

FY 2025-2026 Maternal Health Assuring Agencies + Audit Tools

Guidelines for Local Health Departments Assuring Maternal Health Services (PDF, KB)
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 2025-2026