Select Page

ACCESS FORMS

These COMPLETE packets have all of the necessary documents for timely Eligibility processing.  Click on the button below to access PDF's.

 

18-04a Universal Eligibility Application – New Client Packet
18-05a Universal Eligibility Application – Annual Client Review
18-06a Universal Six Month Self Attestation Packet

FORMULARIOS DE ACCESO RAPIDO

These COMPLETE packets have all of the necessary documents for timely Eligibility processing.  Click on the button below to access PDF's.

 

18-04a Universal Eligibility Application- Brand New Client - Spanish Packet
18-05a Universal Eligibility Application- Annual Client - Spanish Packet
18-06a Universal Six Month Self Attestation- Spanish Packet

ADDITIONAL FORMS (English)

Medical Case Management (MCM) Packet
Grievance Procedures
Notice of Privacy Practices / Social Service Packet

PART A PROGRAM

Clark County Social Service
Ryan White Part A Program
1600 Pinto Lane
Las Vegas, NV 89106

PART B PROGRAM

Office of HIV/AIDS
4126 Technology Way, Suite 200
Carson City, NV 89706
Fax: (775) 684-4056