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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

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Ryan White and ADAP Forms

Florida Department of Health in Nassau County Disease Control Division

If you have never enrolled in the Ryan White program in the State of Florida or if it has been more than one year since you were enrolled, click here for eligibility information for eligibility information or call 904-557-9132.

For current clients who need to complete an annual Ryan White and/or ADAP eligibility assessment, please fill out the forms below, print them, and bring them to your case manager or the nearest Nassau County Health Department Office. Completed forms may also be mailed to FL DOH Nassau, 1620 Nectarine St, Fernandina Beach, FL 32034. If you are unable to print the forms, call us and we will mail them to you or arrange for you to pick them up from us.

Online Forms for Annual Renewal:

For current clients who need to complete a six-month Ryan White and/or ADAP eligibility assessment or if you already have Ryan White and just need to sign up for ADAP, please call 904-557-9132.