AIDS Drug Distribution Program (ADDP)/Health Insurance Continuation Program (HICP)
Form Template
A Physician Certification form from the New Jersey Department of Health AIDS Drug Distribution Program (ADDP)/Health Insurance Continuation Program (HICP).
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Comes with capture fields for physician to indicate whether the applicant is lab confirmed to have HIV, if the applicant meets CDC criteria for AIDS, HIV risk factors, and more. Provides a capture field for applicant to signify permission to release information.
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