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Alabama AIDS Drug Assistance Program

The goal of the Alabama AIDS Drug Assistance Program (ADAP) is to reduce associated morbidity/mortality among HIV infected persons by delaying the progression of HIV disease through prevention and treatment of HIV complications.

ADAP Quarterly Report

The ADAP Quarterly Report for January - September 2015 is now available. This report reflects the number of active clients enrolled in the AIDS Drug Assistance Program.

Alabama AIDS Drug Assistance Program (ADAP) Satisfaction Survey

The ADAP Satisfaction Survey is designed to help improve ADAP medication services. The survey should take approximately 5-10 minutes to complete, and answers and comments will remain anonymous. Take the survey.

ADAP Patient Activity Open Enrollment

Updated:

February 12, 2016

Active:

1139

Medcap:

78

 

 

Forms

Last Revised

ADAP Formulary

October 2015

Alabama's Ryan White Part B Program Eligibility Standard

October 2015

Alabama Ryan White Part B/ADAP Program No Income Statement

October 2015

Alabama Ryan White Part B/ADAP Program SSI/SSDI Acknowledgement Statement

October 2015

ADAP-MEDCAP Formulary Information

October 2015

Alabama Insurance Assistance Program Application Instructions

October 2015

Alabama Insurance Assistance Program Application

October 2015

AIAP Authorization

October 2015

Authorization for Release of Protected Health Information

October 2015

Authorization for Disclosure of Protected Health Information

October 2015

Eligibility: Coordination of Benefits

Nov. 2015

Alabama Ryan White (RW) Part B Services/ADAP/MEDCAP Standard Application Form

October 2015

Alabama's Ryan White/ADAP Certification Statement

October 2015

ADAP Manifestación de certificación del cliente

January 2009

Alabama Ryan White Part B/ADAP Statement of Temporary Housing

October 2015

Bi-Annual Client Eligibility Review (CER) Guidance

October 2015

Alabama's Standard Ryan White/ADAP Eligibility Reassessment Form

October 2015

ADAP - MEDCAP Prescription Form

October 2015

Fuzeon Pre-Approval Checklist

October 2014

Maraviroc (Selzentry™) Pre-Authorization Form

October 2014

Procrit Pre-Approval Form

October 2014

MEDCAP Enrollment Requirements

October 2015

MEDCAP Client Certification Statement

October 2015

National Monitoring Standards Basics

May 2013

Universal Monitoring Standards

May 2013

National Monitoring Standards Ryan White Part B Grantees: Program Part B

May 2013

Contact Us

Alabama AIDS Drug Assistance Program
HIV/AIDS Division
Alabama Department of Public Health
The RSA Tower
201 Monroe Street, Suite 1400
Montgomery, AL 36104
Phone: 1-866-574-9964
Fax: (334) 206-6221


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