To begin the process of becoming a Baby Arizona provider, each provider must complete a Provider Agreement.

The Provider Agreement was created by the Arizona Medical Association (ArMA). The Provider Agreement asks the provider to agree to the following:

• My name, practice address, and phone number may be given to a potential patient by the ADHS Pregnancy Information Hotline and other participating referral system.

• When contacted by a referred patient or the hotline, my office will schedule an appointment to assist in the S.O.B.R.A. eligibility process pursuant to the training we have received.

• My office will perform the same clinical services for a referred patient on the initial visit that we provide patients referred from other sources.

• If a patient is subsequently determined not to be S.O.B.R.A. eligible, we will continue her care based upon a reasonable payment schedule developed between my office and the patient.

• If a patient determined eligible is assigned to another provider or opts to receive care from another provider, we will transfer her records to that provider within ten (10) working days of receiving a signed release from the patient.

Download the Provider Agreement here. [PDF]