Skip Navigation LinksOA_ADAP_MM_2024-10_Discontinuance_of_Telephone_Enrollment_and_the_EW_Attestation_Form OA ADAP MM 2024-10 Discontinuance of Telephone Enrollment and the EW Attestation Form

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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


ADAP MM 2024-10
May 16, 2024


TO:
ADAP & PrEP-AP Enrollment Workers

SUBJECT:
Discontinuance of Telephone Enrollment and the Enrollment Worker Attestation Form (CDPH 9117)

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​ADAP MM 2024-10: Discontinuance of Telephone Enrollment and the Enrollment Worker Attestation Form (CDPH 9117)


The purpose of this memo is to inform AIDS Drug Assistance Program (ADAP) and Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) Enrollment Workers (EW) about a policy update regarding telephone enrollment and the Enrollment Worker Attestation form, also known as form CDPH 9117.

On May 5, 2022, ADAP and PrEP-AP released the Enrollment Worker Attestation form. The form was used by EWs to enroll clients by telephone and to attest that the client was eligible for ADAP/PrEP-AP, agreed to consent language, and will provide documentation within 12 months.

The Enrollment Worker Attestation form was released during California's COVID-19 State of Emergency to remain flexible and ensure clients impacted by the pandemic did not lose eligibility. The COVID-19 State of Emergency has since ended. Effective immediately, telephone enrollment will not be allowed, and the Enrollment Worker Attestation form will be discontinued. New and current clients can continue to enroll/re-enroll in-person, by secure e-mail or fax.

Please contact your OA Advisor if you have any questions regarding the information provided in this memo.

Thank you,

Joseph Lagrama Signature.png

Joseph Lagrama
ADAP Branch Chief
California Department of Public Health