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Ryan White Part B Program Application Instructions The Ryan White Part B Program gives help to low income people living with HIV/AIDS in Maine. Use this application to apply for help paying for dental insurance.
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Document Date: 2014-09-18 15:53:39

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File Size: 95,59 KB

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City

Washington / Androscoggin / York / Piscataquis / Hancock / Somerset / Knox / Aroostook / Kennebec / Lincoln / Penobscot / Waldo / Franklin / Oxford / Sagadahoc / /

Currency

USD / /

Facility

Regional Medical Center / /

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IndustryTerm

dental insurance / insurance carrier / /

MedicalCondition

HIV/AIDS / /

Organization

Printed Name Signature Date Office / Regional Medical Center / Maine Department of Health and Human Services Authorization / /

Person

Ryan White / /

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ProvinceOrState

Maine / Washington / /

RadioStation

Knox / /

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