Additional Forms and Documents. Certificate of Completion, Sample Deed Notification Template, Sample Agent Authorization Form.The beneficiary must be Medicaid or NC Health Choice eligible and a Carolina. Complete Health member on the date of service. Download our free Return to Work Letter template and explore samples for a smooth transition back to the workplace. Beneficiary's name — Enter the beneficiary's name as it appears on the NC Medicaid identification card. Enter the beneficiary's current address. 3. Prior approval (PA) is required for many DHB services. The preferred method to submit PA requests is online via the NCTracks Provider Portal. These consent form templates have been posted for your reference.