Private admission submissions
One referral.
One step at a time.
Start an inquiry or send documents for an existing referral. You can return and upload more as often needed. You do not have to send everything at once.
All requirements remain visible, in their required order.
Step 1
Send these documents first.
Begin by uploading the most recent documents listed below. Receiving these first helps the team expedite review and determine eligibility.
- Comprehensive Clinical Assessment (CCA)
- CCA Addendum (if available)
- Person-Centered Plan (PCP)
- Psychological Evaluation (if available)
Placement cannot occur without an MCO authorization.
Authorization requires a CCA addendum dated within 30 days that recommends Level III, and a PCP update recommending Level III with a Service Order (PCP section 3) signed by a doctor.
What is the Service Order?
It is a required section of the PCP, signed by a licensed physician, physician assistant or nurse practitioner. The signature confirms a medical provider has reviewed the treatment plan and agrees that the recommended service—Level III Residential Treatment—is medically necessary.
Without a signed Service Order, the MCO cannot approve authorization and the child cannot be admitted.
Step 2
Mandatory documents.
After the Step 1 documents, gather the following to complete admission. Keep each date requirement and condition in view.
Download the Resident Admission Application ↓- Completed Resident Admission Application
- Signed Consent Forms
- Complete CCA — within 1 year
- Updated CCA — within 30 days of admission, recommending Level III
- CALOCUS Assessment — indicating a Level III recommendation
- Updated PCP Document — Word format
- Service Order with Signatures — within 30 days of admission date
- IEP/504 Documentation (if applicable)
- Current School Records
- Health Records and Immunization Details
- Custody Order Documentation
- Court Orders (if applicable)
- Medicaid Card
- Birth Certificate
- Social Security Card
- Guardian Identification
- 30-Day Prescription Record
- Prescriptions sent to the program's pharmacy — Lewisville Drug Company, 6715 Shallowford Road, Lewisville, NC 27023, (336) 946-0220
Step 3
Additional documents.
WS/FCS forms.
To enroll a child who is in DSS custody in Winston-Salem/Forsyth County Schools, the following are needed:
- WS/FCS New Student Enrollment
- Verification of Custody letter (DSS 5760)
- Notification of Placement Change (DSS 5133)
- Immediate Enrollment Form (DSS 5135)
The three DSS forms are provided by DSS. Ask the referring DSS worker for the completed forms; do not substitute unrelated enrollment paperwork.
Private submission to the admissions team
Tell us what you’re sending.
Submit an initial inquiry without attachments, or add documents to a referral. Files are not exposed publicly. Submissions are used solely for evaluating the prospective resident’s admission.