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These forms are provided by the Division of HIV/AIDS Services (DHAS). Each of the forms is provided in two formats: PDF and Word Template.
| Form # |
Title |
PDF |
Word |
| DHAS-27 |
Application for Participation in the AIDS Drug Distribution Program (ADDP) |
[36k] |
[131k] |
| DHAS-37 |
Certification by Physician (formerly DAPC-22) |
[19k] |
[45k] |
| DHAS-38 |
Certification by Pharmacist (formerly DAPC-23) |
[17k] |
[31k] |
| DHAS-31 |
Application for Participation in the Health Insurance
Continuation Program (HICP) (formerly DAPC-31) |
[35k] |
[105k] |
|
