Call the DC ADAP Hotline for questions: (202) 671-4815
Applicant Forms:
- ANNUAL Application to the DC AIDS Drug Assistance Program (DC ADAP) [PDF]
If you have problems filling out the application or have questions about the DC ADAP Program, or any required documentation, please call (202) 671-4815 for assistance. All applications must be signed and dated in order to determine eligibility. Please retain a copy of all documentation for your record. Please note there must be individual documents for each eligibility requirement. Your application can now be submitted online at https://dcenroll.ramsellcorp.com Contact DCADAP for your registration code.
- Six (6) Month ADAP Recertification (Self Attestation) Form [PDF]
- Zero Income Statement [PDF]
- Authorization for the Release of Health Information [PDF]
En Español:
Provider Forms:
Prior Authorization Forms:
- Daklinza
- Daliresp; Initial Form
- Daliresp; Renewal Form
- Harvoni
- Lamivudine and Tenofovir
- Mavyret
- Sovaldi
- Viekira
- Zepatier
- Hepatitis C Beneficiary Disclosure & Commitment Form
Other Prior Authorization Forms: