Partners DHB-3051 form¬†should be completed by the member’s primary care provider or physician.

Fax the completed form to Partners at 704-457-5261.

Once this form is completed, a member of our team will contact you within 30 days to schedule a face-to-face meeting to complete your assessment.

After the assessment has been completed and the start date has been determined, an authorization will be created/submitted by Carolina Complete Health (CCH) and will be shared with the Provider agency. Providers will receive notification of authorization via ProviderCONNECT.

View the Personal Care Services Clinical Coverage Policy.

If you have questions related to PCS, please submit them to