Get Ny Doh-3608 2008-2026

The NY DOH-3608 form is essential for patients seeking assistance through the Uninsured Care Programs in New York. This guide provides clear, step-by-step instructions to help users complete the form online accurately and efficiently.

Follow the steps to fill out the NY DOH-3608 online.

1. Press the ‘Get Form’ button to access the NY DOH-3608 form in the online editor.
2. Begin by entering the patient's information in the designated fields, including last name, first name, middle initial, address, city, state, zip code, date of birth, and Social Security number.
3. Complete the physician information section by providing the physician's name, DEA number, NYS license number, hospital or facility name, NPI number, and office telephone number.
4. Indicate an alternate contact for medical follow-up by entering their name and telephone number.
5. The physician must verify the information provided by signing the form in the designated area and including the date.
6. In the medical information section, answer all questions regarding the applicant's HIV status, including disease staging, recent test results, and medical history.
7. For treatment history, indicate whether a comprehensive HIV evaluation has been done, if anti-retroviral treatment has been recommended, and whether the applicant is participating in clinical trials.
8. After completing all sections, ensure that any necessary lab reports are attached as indicated. Review all information for accuracy.
9. Save your changes, then download, print, or share the completed form as needed, and submit it as instructed.

Complete your NY DOH-3608 form online today for assistance!