DOH Form 150-101 HIV & Health Status Information Form - Pre-exposure Prophylaxis Drug Assistance Program (Prep Dap) - Washington

DOH Form 150-101 HIV & Health Status Information Form - Pre-exposure Prophylaxis Drug Assistance Program (Prep Dap) - Washington

What Is DOH Form 150-101?

This is a legal form that was released by the Washington State Department of Health - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DOH Form 150-101?A: DOH Form 150-101 is the HIV & Health Status Information Form for the Pre-exposure Prophylaxis Drug Assistance Program (Prep Dap) in Washington.

Q: What is the Pre-exposure Prophylaxis Drug Assistance Program (Prep Dap)?A: Prep Dap is a program in Washington that provides assistance with obtaining pre-exposure prophylaxis (PrEP) drugs for HIV prevention.

Q: Who can use DOH Form 150-101?A: Anyone in Washington who is seeking assistance with obtaining PrEP drugs through Prep Dap can use this form.

Q: What information is required on the form?A: The form asks for personal information such as name, contact details, and information about HIV testing and health status.

Q: Is there a cost to use Prep Dap?A: Prep Dap offers assistance with obtaining PrEP drugs at no cost for eligible individuals who meet the program's criteria.

Q: How long does it take to process the form?A: The processing time for the form may vary, but it typically takes several weeks for the application to be reviewed and approved.

Q: Can I apply for Prep Dap if I don't have health insurance?A: Yes, Prep Dap is available to individuals with or without health insurance.

Q: Can I apply for Prep Dap if I'm not a resident of Washington?A: No, unfortunately, Prep Dap is only available to residents of Washington.

Q: Who should I contact if I have questions about DOH Form 150-101?A: For any questions or concerns about the form, you can reach out to the Washington State Department of Health (DOH) or your healthcare provider.

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Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Washington State Department of Health;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DOH Form 150-101 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.

Download DOH Form 150-101 HIV & Health Status Information Form - Pre-exposure Prophylaxis Drug Assistance Program (Prep Dap) - Washington

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