The Trillium Tailored Plan launches on April 1, 2023.
NC Medicaid changed the start date for Tailored Plans. The new start date is April 1, 2023. Until April 1, 2023, you will keep getting services the way you do now.
Information and processes on this page will be changing in the weeks to come.
Learn about Tailored Plan here

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Trillium has launched our Emergency Operations in preparation for Hurricane Ian. Trillium’s Member and Recipient Services will remain active and will switch to only operating that number (1-877-685-2415) if required due to power outages. If conditions worsen, we encourage everyone to use staff emails to keep Member & Recipient Services open. In all areas, 911 should be used for TRUE MEDICAL EMERGENCIES. Trillium staff are not first responders and will not be able to physically attend to emergencies in the community.

Employer of Records - Documents Library

DOCUMENTS | FORMS

For the best results, please save the Adobe PDF form to a local drive on your computer before completing the form.

Recruitment

Fillable	To print
Employee Schedule Hepatitis Employee Notification Interview Questions Job Description Personal Reference Professional Reference Release for Professional Reference Release of Information to Trillium Health Resources Telephone Screening Form	Employee Schedule Hepatitis Employee Notification Interview Questions Job Description Personal Reference Professional Reference Release for Professional Reference Release of Information to Trillium Health Resource Telephone screening Form

Training

Fillable	To print
Employee Training Log Emergency Telephone Numbers Confidentiality Agreement	Employee Training Log Emergency Telephone Numbers Confidentiality Agreement

Supervision

Fillable	To print
Employee Performance Evaluation I Employee Performance Evaluation II Employee Performance Evaluation III Employee Supervision Log Employee Supervision Plan Employee Support Agreement Notice of Unsatisfactory Performance Reimbursement Request Form for Mileage	Employee Performance Evaluation I Employee Performance Evaluation II Employee Performance Evaluation III Employee Supervision Log Employee Supervision Plan Employee Support Agreement Notice of Unsatisfactory Performance Reimbursement Request Form for Mileage

Personnel File

Fillable	To print
Personnel File Index Employee Emergency Contact Information Sheet	Personnel File Index Employee Emergency Contact Information Sheet

Employer of Record Checklist

Fillable	To print
Emergency Plans Review Employer of Record Self-Assessment Health & Safety Checklist Request for Out-of-State Travel	Emergency Plans Review Employer of Record Self-Assessment Health & Safety Checklist Request for Out-of-State Travel

Incident Reporting

Fillable	To print
Back-Up-Staffing Incident Reporting Form Level I Incident Report Form	DHHS Incident & Death Report Back-Up-Staffing Incident Reporting Form Level I Incident Report

Annual Review

Fillable	To print
Employee Training Log Trillium Plan of Correction	Employee Training Log Trillium Plan of Correction

The audience for documents: Individuals/Families receiving services/ Service Providers/Trillium Team Members

Page last verified on April 07, 2021

See something that needs to be updated?

If you find any wrong or out of date information on our pages, we want to know. Please email Info@TrilliumNC.org with any corrections.

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You can help keep fraud, waste, abuse, unethical, or illegal activity out of our workplace. If you are uncomfortable communicating a concern in person, report it anonymously by calling the toll-free hotline number, 1.855.659.7660, or report it online at EthicsPoint and follow the instructions on the screen

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