Ryan White Provider Resources and Guidelines
The following documents are intended for contracted Ryan White Providers.
Service Standards
Handbooks
Forms
Enrollment for the following services: outpatient ambulatory health, medical specialty, psychiatric and mental health, outpatient and residential substance use disorder.
- RW-1 Application English (RW-1E)* | Spanish* (RW-1S)
- RW-2 Referral English (RW-2E)* | Spanish (RW-2S)*
- RW-3 Recertification English (RW-3E )* | Spanish (RW-3S)*
- HIV Care Connect Client Consent Form English | Spanish
- RWPC Patient Information English | Spanish
- Secondary Dental Services English | Spanish
Enrollment for all other Ryan White providers
Clinic, Lab, and Pharmacy
- Drug Formulary
-
Resistance Test
Form*
- Allowable Dental Services
- Dental Practice Guidelines
- Excluded Procedure Codes
- Standards of Care Committee Practice Guidelines
- Medical Practice Guidelines
- 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 (Rev. 2025)
Case Management
Resources
- HRSA Ryan White HIV/AIDS Program Performance Measures
- Ryan White Primary Care Contract Administrator—(619) 293-4716; please contact us if you have any questions.
Popular Services