HIV, STD and TB Services

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Free Medications through the AIDS Drug Distribution Program (ADDP)

These forms are provided by the Division of HIV/AIDS Services (DHAS). Each of the forms is provided in two formats: PDF and Word Template.

Form # Title PDF Word
DHAS-27 Application for Participation in the AIDS Drug Distribution Program (ADDP) and/or the Health Insurance Continuation Program (HICP) [36k] [131k]
DHAS-37 Certification by Physician (formerly DAPC-22) [19k] [45k]
DHAS-38 Certification by Pharmacist (formerly DAPC-23) [17k] [31k]