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

• Provider Handbook
• Specialty Pools Information
  •    Specialty Pools Providers
    

Forms

• Covered California Handout (English)
• Covered California Handout (Spanish)

      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
• RWPC TA Counselor Certification 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

• Case Management Services Description

HIV/AIDS Bureau Performance Measures

• http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html

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 August 15, 2019.