Office of HIV Prevention and Care
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ADAP and Ryan White Part B Program Forms
Forms, applications, and policies for the ADAP and Ryan White Part B Program are available below.
- ADAP Patient Activity Open Enrollment
- Forms and Applications
- Policies, Standards, and Guidance
- Resources
- Contact Us
ADAP Patient Activity Open Enrollment
Updated: July 10, 2025
Active: 1,092
Medcap: 57
Forms and Applications
- Alabama's Part B and ADAP Income Verification Form (April 2025)
- Sunlenca Prior Approval Authorization Form (April 2024)
- ADAP 90 Day Travel Form (January 2024)
- ADAP Employer Sponsored Insurance Form (January 2024)
- ADAP-Incarcerated Form (January 2024)
- BCBS Dental Binding Arbitration | Spanish Version (January 2020)
- Ryan White Part B Program Authorization for Release of Protected Health Information | Spanish Version (August 2020)
- BCBS Authorization for Disclosure of Protected Health Information | Spanish Version (January 2017)
- BCBS Eligibility Coordination of Benefits | Spanish Version (November 2015)
Policies, Standards, and Guidance
- Alabama RWHAP Part B Income Eligibility Guidelines (January 2025)
- Alabama Ryan White HIV/AIDS Program Part B and AIDS Drug Assistance Program Eligibility Policy (April 2025)
- Alabama's Ryan White ADAP Program Policy and Procedures Manual for Providers (April 2025)
- Alabama RWHAP Part B and ADAP Annual Certification Schedule (January 2023)
- National Monitoring Standards Basics (August 2023)
- Universal Monitoring Standards (June 2022)
- National Monitoring Standards Ryan White Part B Grantees: Program Part B (June 2022)
- ADAP-Incarcerated Guidance (November 2022)
Resources
- Alabama's Ryan White Part B Program Formulary by Drug Class Name (September 2024)
- Alabama's Ryan White Part B Program Formulary by Generic Name (September 2024)
- Thera Patient Support for Trogarzo (May 2021)
- Resources to Address Potential Barriers to Long-Acting Injectable Antiretroviral Therapy (May 2021)
Contact Us
Alabama AIDS Drug Assistance Program
Office of HIV Prevention and Care
Alabama Department of Public Health
The RSA Tower
201 Monroe Street, Suite 1200
Montgomery, AL 36104
ADAP Eligibility Hotline: 1-866-574-9964 (Monday-Friday, 8 a.m. - 5 p.m.)
Fax: (334) 206-6221
Page last updated: July 10, 2025