HIV, STD and Hepatitis Branch
Ryan White Primary and Specialty Care (Medical and Dental)
Services
The following documents are intended for Ryan White Primary Care Providers.
Handbooks
Forms
ENROLLMENT
-
RW-1E
Application English*
- 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
-
Secondary
Dental Services English
-
Secondary
Dental Services Spanish
CLINIC, LAB AND PHARMACY
- Drug Formulary
-
Resistance Test Form*
- RWPC Allowable Dental Services
- RWPC Dental Practice Guidelines
- RWPC Excluded Procedure Codes
- RWPC Standards of Care Committee Practice Guidelines
- RWPC Medical Practice Guidelines
- RWPC Nutritional Supplement Form
-
Sexual
Health Risk Assessment English
- Sexual Health Risk Assessment Spanish
- Specialty Care Authorization Form - Medical
- Specialty Care Authorization Form – Dental
- Specialty Care Authorization Form – Home Health and Hospice
- Viral Load Test Form*
- Provider Registration Form
CASE MANAGEMENT
HIV/AIDS Bureau Performance Measures
If you have any questions, please contact the Ryan White Primary
Care Contract Administrator at (619) 293-4722.
For more information, please call (619)
293-4700 or send us an email.
Last updated October 30, 2019.