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CC4C Screening and Referral Form - Cabarrus Health 2026
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- Click ‘Get Form’ to open the CC4C Screening and Referral Form in our editor.
- Begin by entering the child's name, referral date, and date of birth in the designated fields. Ensure accuracy as this information is crucial for processing.
- Select the child's gender and race from the provided options. This helps in understanding demographic needs.
- Fill in the Medicaid ID number or select the appropriate insurance status. If applicable, indicate if Medicaid has been applied for.
- Complete the Parent/Guardian Information section, including names, contact details, and whether an interpreter is needed.
- In the Target Populations for Referrals section, check any relevant boxes that apply to the child’s situation to ensure they receive appropriate services.
- If making a direct referral from a medical home, check the corresponding box and specify reasons if necessary.
- Review all entered information for accuracy before submitting. Once complete, submit the form to CMARC staff at your local health department.
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