To become a Baby Arizona provider designated staff must complete the Baby Arizona
Training. This training can be used as a refresher or to train new staff in your
office.
Baby Arizona Web Training Video
(Less than one hour in length)
The following documents are required for submitting the Baby Arizona application
as described in the training.
Provider Baby Arizona Documents
All materials below are in Adobe Portable Document Format (PDF)
Participating Provider Agreement
- English
Information Change
Form (FA-412 - English)
Information Change
Form (FA-412 - Spanish)
Baby Arizona Application
(FA-805)
Turnaround Document (FA-865
TAD)
Baby Arizona
Checklist (FAA-1190A)
AHCCCS Information for applicants( FAA-1211AFLYNA-English)
AHCCCS Information for applicants( FAA-1211AFLYS-Spanish)
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