Women's Health Branch: Agreement Addenda, Audit Tools and Budget Forms
The Women's Health Branch 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 2020-2021 Agreement Addenda, Audit Tools, and Budget Forms - 12/17/20
FY 2020-2021 Family Planning Agreement Addenda + Audit Tools - 12/04/20
- Family Planning Agreement Addenda (PDF, 327 KB)
- Resources for Advancing Health Equity - June 2020 (PDF, 327 KB) - 06/12/20
- Family Planning Agreement Addenda Audit Tools 12/04/20
- Family Planning Outcome Objectives (OOs) by Objective Topic 2020-2021 (PDF, 2 MB)
- Family Planning Outcome Objectives (OOs) by County 2020-2021 (PDF, 1.1 MB)
- FPAR Data Requirement Guide (PDF, 187 KB) - 03/24/20
- TANF Expenditure Examples/Ideas (PDF, 91 KB) - 06/11/19
- Memorandum of Understanding (MOU) Sample Family Planning Assurance Plan (Word, 77 KB) - 03/24/20
FY 2020-2021 Maternal Health Agreement Addenda + Audit Tools - 06/30/20
- Maternal Health Agreement Addenda (PDF, 2 MB)
- DHHS 3954 - Maternal Health Agreement Addenda Audit Tool (PDF, 343 KB) - 06/30/20
- Resources for Advancing Health Equity - June 2020 (PDF, 327 KB) - 06/12/20
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, 208 KB) - 06/30/20
- Maternal Health Outcome Objectives (OOs) by Objective Topic 2020-2021 (PDF, 1.5 MB) - 06/02/20
- Maternal Health Outcome Objectives (OOs) by County 2020-2021 (PDF, 2.3 MB) - 06/02/20
FY 2020-2021 Maternal Health Assuring Agencies + Audit Tools - 06/30/20
- Guidelines for Local Health Departments Assuring Maternal Health Services (PDF, 59 KB)
- Sample Assurance Plan Memorandum of Understanding (DOC, 34 KB)
- DHHS 4150 - Agencies Assuring Maternal Health Care Audit Tool (PDF, 165 KB) - 06/30/20
FY 2020-2021 High Risk Maternity Clinic Agreement Addenda + Audit Tools - 12/17/20
- High Risk Maternity Clinic Agreement Addenda (PDF, 295 KB)
- Resources for Advancing Health Equity - June 2020 (PDF, 327 KB) - 06/12/20
- When approved, it will be posted (PDF, KB) - 12/17/20
Health Behavior Intervention Audit Tool
Health Behavior Intervention Audit Tool (DHHS 4149) (PDF, 176 KB)
- Open Window Budget Form FY 2020-2021 (XLS, 1013 KB)
- How to Fill Out the Open Window Budget Form (DOC, 344 KB)
FY 2019-2020 Agreement Addenda, Audit Tools, and Budget Forms - 12/17/20
FY 2019-2020 Family Planning Agreement Addenda + Audit Tools - 12/03/19
- Family Planning Agreement Addenda (PDF, 269 KB)
- Resources for Advancing Health Equity - March 2018 (PDF, 175 KB)
- Family Planning Agreement Addenda Audit Tools
- NC Program Review Tool (DOCX, 85 KB) - 04/23/19
- Female Record (DOC, 21 KB) - 12/03/19
- Male Record (DOC, 160 KB) - 04/23/19
- Family Planning Outcome Objectives (OOs) by Objective Topic 2019-2020 (PDF, 1.3 MB)
- Family Planning Outcome Objectives (OOs) by County 2019-2020 (PDF, 1.1 MB)
- TANF Expenditure Examples/Ideas (PDF, 91 KB) - 06/11/19
- FY 2019-2020 Maternal Health Agreement Addenda + Audit Tools - 01/27/20
- Maternal Health Agreement Addenda (PDF, 168 KB)
- DHHS 3954 - Maternal Health Agreement Addenda Audit Tool (PDF, 341 KB) - 01/27/20
- Resources for Advancing Health Equity - March 2018 (PDF, 175 KB)
- DHHS 4153 - Home Visit for Postnatal Assessment and Follow-Up Audit Tool (PDF, 173 KB) - 08/06/19
- Maternal Health Outcome Objectives (OOs) by Objective Topic 2019-2020 (PDF, 892 KB) - 05/15/19
- Maternal Health Outcome Objectives (OOs) by County 2019-2020 (PDF, 1.7 MB) - 05/15/19
FY 2019-2020 Maternal Health Assuring Agencies + Audit Tool - 07/15/19
FY 2019-2020 High Risk Maternity Clinic Agreement Addenda + Audit Tools - 12/17/20
- High Risk Maternity Clinic Agreement Addenda (PDF, 158 KB)
- Resources for Advancing Health Equity - March 2018 (PDF, 175 KB)
- DHHS 4148 - High Risk Maternity Clinic Agreement Addenda Audit Tool (PDF, 361 KB) - 12/17/19
Health Behavior Intervention Audit Tool
Health Behavior Intervention Audit Tool (DHHS 4149) (PDF, 176 KB)
- Open Window Budget Form FY 19-20 (XLS, 964 KB)
- How to Fill Out the Open Window Budget Form (DOC, 344 KB)
Last Modified: December 17, 2020
