skip to content

It's a New Day in Public Health.

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

skip to content
 

Core Eligibility Registration

HIV/AIDS

**REGISTRATION FORM**
This registration is for the Florida Department of Health, Eligibility Training required for all staff performing eligibility for Ryan White Part B Consortia, GR Network, HOPWA and ADAP. In order to receive a certificate of completion, you must complete a registration form and attend the entire training. This is an on-line training done from your computer and a phone line. The trainings are on Wednesdays from 9 a.m. to 12 p.m. Eastern Time.

 

 

Attachments

All files are pdf/doc format and under 5mb in size. All files open in a new window

Attachment

Name

Requirement

List of Attachments

Attachment Summary

N/A

Attachment A

Ryan White Program Definitions of Eligible Services

N/A

Attachment B

DH 1120, Acceptable Use and Confidentiality Agreement

Required

Attachment C

Core Eligibility Requirements Brochure (English, Spanish, and Creole)

N/A

Attachment D

DH 150-884, Eligibility Application

Required

Attachment E

Eligibility Staff Assessment Worksheet

Required

Attachment F

Six Month Re-Determination Review Form

Required

Attachment G

DH 8000-PHSPM, Notice of Eligibility

Required

Attachment H

Notice of Ineligibility

Required

Attachment I

Insurance Waiver Form

Required

Attachment J

Self Employment Tracking Sheet

Required

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead contact these offices by phone or in writing.