FORMS AND DOWNLOADS

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HIV/AIDS TREATMENT PROGRAM
(RYAN WHITE PART B/ADAP/HOPWA):
  2007 Client Application for Assistance
  2007 Income Eligibility Guidelines
  Income Verification Form
  Provider's Medical Certification Form
  Veteran's Eligibility Verification Form
  Prior Authorization Request Form
  ADAP Drug Formulary, last updated August 20, 2007
  Transportation Expense Verification Form
  Patient Rights and Responsibilities Form
  Patient Grievance Procedures Form

HIV/AIDS/HEPATITIS CARE AND PREVENTION PLANNING ALLIANCE (CAPPA):
  Membership Application Form
  CAPPA Bylaws
  
HIV COUNSELING AND TESTING:
  Registration Form
 

HIV COUNSELING AND TESTING - FORMS:
  Information and Consent for Testing form, English
  Information and Consent for Testing form, Spanish
  HIV Test Results form
  Waiver of Anonymous Status form
  Client Survey - How Are We Doing?

HEPATITIS:
  Wyoming Viral Hepatitis Protocol
  Hepatitis Testing Informed Consent Form
  Wyoming Department of Health Confidential Disease Report Form
  Hepatitis B and Hepatitis C Supplemental Report Form

HIV/HEPATITIS/STD CONTENT NOTICE:    This site may contain prevention messages that may not be appropriate for all audiences.  Since HIV, Hepatitis, and/or STD infections are spread primarily through sexual practices or by sharing needles, prevention messages and programs may address these topics.  If you are not seeking such information or may be offended by such materials, please exit this site. MEDICAL INFORMATION DISCLAIMER: All information contained on this web site, including information relating to health conditions, products, and treatments, is for informational and educational purposes only.  Although this web site may provide visitors with information to better understand their health and risk factors for specific diseases, the Wyoming Department of Health (WDH) does not intend to provide specific medical advice.  Any information presented is not meant to substitute for the advice provided by your own doctor or other medical professionals.  WDH and the HIV/AIDS/Hepatitis Program urge you to consult with a qualified health care provider for diagnosis, treatment, and answers to your personal health care questions.