MCPA Forms & Brochures
Frequently Asked Questions
Brochure
Instructions for Completing
Inquiry & Release Forms
MCPA Inquiry Form
(to be filled out by you)
Authorization for Release of Medical Records (to be filled out by you)
(Note: You will need Adobe
Acrobat Reader ® to view these forms)
Download Adobe
Acrobat Reader ®
Managed Care Patient Assistance Program
North Carolina Department of Justice
Raleigh, NC 27602-0629
(866) 867-MCPA (6272)
(919) 733-MCPA (6272)
Email: MCPA@ncdoj.gov