Free medications and AIDS drug distribution program forms

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) (formerly DAPC-21)	[36k]	[131k]
DHAS-37	Certification by Physician (formerly DAPC-22)	[19k]	[45k]
DHAS-38	Certification by Pharmacist (formerly DAPC-23)	[17k]	[31k]
DHAS-31	Application for Participation in the Health Insurance Continuation Program (HICP) (formerly DAPC-31)	[35k]	[105k]

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