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.
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:
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.