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 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
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Family Planning Agreement Addenda Audit Tools 06/18/25
- NC Program Review Tool (DOCX, 92 KB)
- Female Record (DOC, 241 KB)
- Male Record (DOC, 167 KB)
- Family Planning Outcome Objectives (OOs) by Objective Topic 2025-2026 (PDF, 1.35 MB) 03/10/25
- Family Planning Outcome Objectives (OOs) by County 2025-2026 (PDF, 681 KB) 03/10/25
- 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 6/17/25
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool 6/17/25
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 06/23/25
Health Behavior Intervention Audit Tool
Health Behavior Intervention Audit Tool (DHHS 4149) (PDF, KB)
- Open Window Budget Form FY 2025-2026 (XLS, 1 MB) 02/10/25
- How to Fill Out the Open Window Budget Form (DOC, 268 KB) 02/10/25
FY 2024-2025 Agreement Addenda, Audit Tools, and Budget Forms
FY 2024-2025 Family Planning Agreement Addenda + Audit Tools 03/25/24
- Family Planning Agreement Addenda (PDF, 346 KB) 03/07/24
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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 06/12/24
- 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, 298 KB) 06/12/24
- Resources for Advancing Health Equity
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, 165 KB) 06/12/24
FY 2024-2025 Maternal Health Assuring Agencies + Audit Tools
- Guidelines for Local Health Departments Assuring Maternal Health Services (PDF, 92 KB) 06/12/24
- Sample Assurance Plan Memorandum of Understanding
- DHHS 4150 - Agencies Assuring Maternal Health Care Audit Tool (PDF, 75 KB) 06/12/24
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
Last Modified: 06-23-2025