HIV Prophylaxis Reimbursement Request Form - Sexual Assault Forensic Examination (Safe) Program - Ohio

HIV Prophylaxis Reimbursement Request Form - Forensic Examination (Safe) Program is a legal document that was released by the Ohio Attorney General - a government authority operating within Ohio.

FAQ

Q: What is the HIV Prophylaxis Reimbursement Request Form?
A: The HIV Prophylaxis Reimbursement Request Form is a document used in the Sexual Assault Forensic Examination (SAFE) Program in Ohio.

Q: What is the purpose of the form?
A: The form is used to request reimbursement for HIV prophylaxis medication for individuals who have undergone a SAFE examination.

Q: What is HIV prophylaxis?
A: HIV prophylaxis is a medication taken to prevent HIV infection.

Q: Who can request reimbursement?
A: The form is used by healthcare providers who have provided a SAFE examination to a sexual assault survivor and prescribed HIV prophylaxis.

Q: How does the reimbursement process work?
A: Once the form is completed, it is submitted to the Ohio Department of Health for review and processing. If approved, reimbursement will be provided.

Q: Is there a deadline to submit the form?
A: The form should be submitted within 12 months of the SAFE examination.

Q: Are there any eligibility criteria for reimbursement?
A: Yes, the individual receiving the SAFE examination must be a resident of Ohio, and the examination must have been conducted by a certified healthcare provider.

Q: Are there any additional requirements or documentation needed?
A: Yes, the form must be accompanied by supporting documentation, such as the SAFE examination report and the prescription for HIV prophylaxis.

Q: Who should I contact for more information?
A: For more information, individuals can contact the Ohio Department of Health or the SAFE Program.