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Form 8718 for South Carolina: What You Should Know

To Be Referred To a Provider North Carolina, South Carolina Form 53501 Taxpayer Notice of Intent to Seek CTC You do not need to submit an application at this time. You can apply for CTC in person using the following ways: Go online at . Type in the “CTC” or “CCS” in the search box. In the search result, select the program you wish to apply for. You must also complete an application form and a completed and signed Consent To Treatment (CWT) form. If you are not a resident of the state of North Carolina, you MUST also complete and sign your CWT form. Complete and return to us the completed CCT application. Form 9516-A — Health Care Providers (PDF) You want to be a provider but can not find a referral? We are proud to offer referral services, and you can request any of the following: Call us at to request a referral to a qualified provider in the state. Provide us with at least one of the following documents: A copy of your most recent certificate of licensure or certification with a state department of health (if you are licensed or certified in NC or SC), or other proof of your ability to practice and accept insurance. A letter of recommendation. A certificate from another hospital or group practice (not more than 12 months old, and not valid for more than one year, if your provider is new to the state). A referral from a health practitioner you have used or refer clients you have used. All other documents necessary to prove that you are qualified. We accept credit cards through PayPal, personal checks, or cashier's checks. In Person Application South Carolina, North Carolina Form 9516-B — Health Care Providers (PDF) You want to be a provider but can not find a referral? We are proud to offer referral services, and you can request any of the following: Call us at to request a referral to a qualified provider in the state. Provide us with at least one of the following documents: A copy of your most recent certificate of licensure or certification with a state department of health (if you are licensed or certified in SC) or other proof of your ability to practice and accept insurance. A letter of recommendation.

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