Ryan White Primary and Specialty Care (Medical and Dental)
The following documents are intended for Ryan White Primary Care Providers.
- RW-1S Application Spanish*
- RW-2E Referral English*
- RW-2S Referral Spanish*
- RW-3E Recertification English*
- RW-3S Recertification Spanish*
- ARIES Client Consent Form English
- ARIES Client Consent Form Spanish
- RWPC Patient Information English
- RWPC Patient Information Spanish
- RWPC Secondary Dental Enroll Form
CLINIC, LAB AND PHARMACY
- Drug Formulary
- Primary Care HIV Flow Sheet
- Resistance Test Form*
- RWPC Allowable Dental Services
- RWPC Dental Practice Guidelines
- RWPC Excluded Procedure Codes
- RWPC Medical Practice Guidelines
- RWPC Nutritional Supplement Form
- RWPC TA Counselor Certification Form
- Sexual Health Risk Assessment English
- Sexual Health Risk Assessment Spanish
- Specialty Pools Authorization Form
- Viral Load Test Form*
- Provider Registration Form
*Available on carbonless paper, please call the Ryan White Primary Care Contract Administrator at (619) 293-4722.
HIV/AIDS Bureau Performance Measures
If you have any questions, please contact the Ryan White Primary Care Contract Administrator at (619) 293-4722.
Last updated February 8, 2016.