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North Carolina Department of Health and Human Services – Health Care Personnel Registry (HCPR) fax number

(919) 733-3207

Health Care Personnel Registry (HCPR), Division of Health Service Regulation (DHSR), North Carolina DHHS

Used for: Submit 24-hour initial reports of allegations against health care personnel and subsequent 5-working-day investigation reports to HCPR; notifications of investigation conclusions to reporting entities.

Fax destination details

Department
Health Care Personnel Registry (HCPR), Division of Health Service Regulation (DHSR), North Carolina DHHS
Purpose
Submit 24-hour initial reports of allegations against health care personnel and subsequent 5-working-day investigation reports to HCPR; notifications of investigation conclusions to reporting entities.
Form
Form No. 4501 — DHSR/HCPR Form No. 4501 Rev. 06/24/2014
Address
2719 Mail Service Center, Raleigh, NC 27699-2719, USA
Voice phone
(919) 855-3968

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Submit in writing within 24 hours of becoming aware of the allegation; use Form No. 4501 for reporting to HCPR; further instructions appear on the form and DHSR/HCPR materials.

Review official form instructions

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