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Form CDPH9117 Enrollment Worker Attestation - AIDS Drug Assistance Program (Adap) and Pre-exposure Prophylaxis Assistance Program (Prep-Ap) - California
What Is Form CDPH9117?
This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the CDPH9117 Enrollment Worker Attestation?A: The CDPH9117 Enrollment Worker Attestation is a form used in California for the AIDS Drug Assistance Program (ADAP) and Pre-exposure Prophylaxis Assistance Program (PrEP-AP).
Q: What are the ADAP and PrEP-AP programs?A: The AIDS Drug Assistance Program (ADAP) provides medication assistance to low-income individuals living with HIV/AIDS. The Pre-exposure Prophylaxis Assistance Program (PrEP-AP) provides medication assistance to individuals at high risk of HIV infection.
Q: Who is the CDPH9117 Enrollment Worker Attestation form for?A: The form is for enrollment workers who assist individuals in applying for the ADAP and PrEP-AP programs.
Q: What is the purpose of the form?A: The form serves as an attestation by the enrollment worker that they have provided accurate information to the client and have completed the necessary eligibility screening and enrollment processes.
Form Details:
- Released on April 1, 2022;
- The latest edition provided by the California Department of Public Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CDPH9117 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.
