FL RW Portal

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Please select a form from the list below as needed.

Note : Below are forms to fill out to enroll for Ryan White services. Please pick the correct form(s) and submit through the portal or take the form to your case manager. If you need any help with the forms, please reach out to the helpdesk at HIVAppsupport@flhealth.gov

Form #	Form Type	Description	Actions
1	Eligibility Application Form	Application to Receive Allowable Services for HIV/AIDS Patient Care Programs	New Form Print Blank Form
2	Recertification Form	Patient Care Core Eligibility Recertification Form	New Form Print Blank Form
3	Initiation of Services (DH3204)	Initiation of Services Form	New Form Print Blank Form
4	Authorization to Disclose Confidential Information (DH3203)	Authorization to Disclose Confidential Information Form	New Form Print Blank Form
5	Self Employment Tracking Sheet	Self-Employment Tracking Form	New Form Print Blank Form
6	Documentation Upload Form	Documentation Upload Form	New Form Print Blank Form
7	ADAP Statement of Agreement	ADAP Statement of Agreement and Acknowledgement Form	New Form Print Blank Form
8	Notice of Privacy Practices	Notice of Privacy Practices Form	New Form Print Blank Form

System Support

FL RW Portal

Patient Care Forms List