Wisconsin HIV Integrated Prevention and Care Plan
Ryan White Documents
Counseling and Testing Documents
HIV Partner Services Documents
Wisconsin AIDS/HIV Drug Assistance (ADAP) and Insurance Assistance Program Documents
- Fact Sheet, P-42115 (PDF)
- Client Disclosure Authorization, F-01829 (Word)
- Application form, F-44614A (PDF) (English and Spanish)
- Part B (Physician Portion) of Application form, F-44614B (PDF) (English and Spanish)
- Instructions for Completing Application form, F-44614I (PDF) (English and Spanish)
- Six-Month Verification form (SMRF) (English and Spanish), F-00851 (PDF)
- Frequently Asked Questions: Impact of the Affordable Care Act (ACA) on the Wisconsin AIDS Drug Assistance Program (ADAP) and Health Insurance Premium Subsidy Program, P-00605 (PDF)
ADAP Information for Pharmacies
- To become an ADAP provider, submit the ADAP Provider Enrollment Application.
- ADAP providers with claims or billing questions should call Provider Services at 800-947-9627.
Last Revised: February 3, 2019