RWPC Contractor Resources

Ryan White Primary and Specialty Care (Medical and Dental) Services

The following documents are intended for Ryan White Primary Care Providers.

If you have any questions, please contact the Ryan White Primary Care Contract Administrator at (619) 293-4708.

Handbooks

• Provider Handbook
• Specialty Pools Handbook

Forms

       Enrollment

• RW-1AE Application Concurrent with ADAP*
• 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
• RWPC Secondary Dental Enroll Form
• LIHP Referral Criteria

       Clinic, Lab, and Pharmacy

• Drug Formulary
• Primary Care HIV Flow Sheet
• Resistance Test Form*
• RWPC Allowable Dental Services
• RWPC Dental Practice Guidelines
• RWPC Excluded Procedure Codes
• RWPC Global Basic Services List
• RWPC Medical Practice Guidelines
• RWPC Nutritional Supplement Form
• RWPC TA Counselor Certification Form
• Sexual Health Risk Assessment English
• Sexual Health Risk Assessment Spanish
• Specialty Pools Authorization Form
• Viral Load Test Form*
• Clinic Information Form

• *Available on carbonless paper, please call the Ryan White Primary Care Contract Administrator at (619) 293-4712.

HIV/AIDS Bureau Performance Measures

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