HIV/AIDS Care and Treatment Forms
Program Application (OA-HIPP)
Program Application (OA-PCIP)
Consent Form (OA-PCIP)
Instructions for Completion of the AIDS Medi-Cal Waiver Program Medi-Cal Provider Application
Client Report Form (OA-HIPP or OA-PCIP)
Financial Eligibility Form (OA-HIPP or OA-PCIP)
Diagnosis Form (OA-HIPP or OA-PCIP)
Support Verification Form (OA-HIPP or OA-PCIP) - This form must be submitted by clients who receive full financial assistance from family, friends, and/or homeless shelters.
Consent Form (OA-HIPP)
Self-Employment Form (OA-HIPP or OA-PCIP) - This form must be submitted by clients who are self-employed and are unable to provide pay stubs or tax records.
Public Assistance Screening Form (OA-HIPP or OA-PCIP)
ARIES User Registration Form
CDPH 8693 (SP)
ARIES Forma de Consentimiento de Compartir/No Compartir
ARIES Client Share/Non-Share Consent Form
Medicare Part D Premium Payment Program Application
Enrollment Worker Confidentiality Agreement (OA-HIPP or OA-PCIP) - This form must be submitted by each certified enrollment worker once every two years.
Identification Verification Form (OA-HIPP) - This form must be submitted by non-ADAP clients who do not have a valid California ID.
Partial Payment Agreement (OA-HIPP) - This form must be submitted by clients who have a monthly insurance premium that exceeds the OA-HIPP program threshold.
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