Alzheimer and Dementia Kit

Members with cognitive impairments or sensory-related needs who are enrolled in Carolina Complete Health’s Care Management program are eligible to receive a sensory support kit tailored to their developmental and/or diagnostic needs.

Eligibility

Carolina Complete Health members must be 18 years or older and be diagnosed with a neurological impairment. One kit per member per plan year (April 1 - March 31).

ALZHEIMER AND DEMENTIA KIT FORM

Member Name * As it appears on your Carolina Complete Health Member ID card

Member ID Number * As it appears on your Carolina Complete Health Member ID card

Member Date of Birth *

Member Address * Carriers do NOT deliver to P.O. Boxes of APO/FPO Addresses. All addresses must be submitted in English. An order that is addressed incorrectly may result in the shipment being sent back to our facility causing extended delays or order cancellation.

City *

Zip Code * Must be 5 digits

Member Phone Number *

Member Email Address *