• Physicians (allopathic or osteopathic)
• Dentists 
• Physician assistants 
• Nurse practitioners 
• Nurse mid-wives

(Family or General Practice, OB/GYN, Pediatrics, or Internal Medicine are required primary care specialties)
 

• Must be a United States citizen
• Have a valid offer of employment at an eligible service site
• Contract with the State of Arizona to serve full-time for a minimum of two years
• Provide primary care services at the approved service site
• Be appropriately licensed and/or certified
• Have no other unfulfilled obligations

• Provide primary care services in a rural private practice
• Be located in an AzMUA (to determine if a site or an area is designated as a Health Professional Shortage Area (HPSA) or Medically Underserved Area/Population (MUA/P), visit the Shortage Designation Advisor website.)
• Accept AHCCCS and Medicare assignments
• Charge for services at the usual and customary rates prevailing in the primary care area
• Have a sliding-discount-to-fee scale in place
• Notify consumers of the availability of the sliding-discount-to-fee scale to eligible individuals

Sliding discount-to-fee schedules must be based on current Federal Poverty Guidelines and adhere to A.A.C. R9-1-504 sliding fee schedule submission and content.

Locating eligible employment is the responsibility of the physician. The following organizations frequently list employment opportunities. The provider should confirm site program eligibility before entering into agreements if they wish to be considered for the program.

Arizona Association of Community Health Centers

3R Net

For a list of sites that offer a sliding discount-to-fee scale and may be eligible for these programs, refer to our Sliding Fee Scale Clinics web page. Please contact this office to determine if a site is eligible.

Actual award amounts may differ from the above guidelines dependent on the availability of funds and outstanding loan balances.
 

For your convenience, see list of electronic forms below:

• Completed applications must be mailed.
• Only applications with original signatures will be accepted. 
• Electronic or faxed submissions will not be accepted.

The following links are in PDF format.  To download, Acrobat Reader™ is required.

• Primary Care Provider Application
• Service Site Application, Arizona Loan Repayment Program
• Substitute W-9 Form [PDF 667K] (must be submitted with provider application)

The following forms are for use by contracted Loan Repayment Program providers.  These forms are based contract start dates and must be submitted to ADHS quarterly with the appropriate original signatures in order to process Loan Repayment Program payments.

• Service Verification Form [PDF 8K]
• Encounter Report [PDF 7K]

Obligated service begins on the date indicated on the contract. Service prior to the start date does not count toward the service obligation. Loan repayments are made directly to the lender(s) indicated by the provider. Payments are generated quarterly by the submission of the service verification and encounter reports immediately following the completion of obligated service.

Arizona Public Non-Profit Loan Repayment Program
Funding is available for loan repayment to primary care providers and dentists working in urban or rural, public, non-profit practices located in a federally designated HPSA (Health Professional Shortage Area).

Looking for volunteer opportunities for healthcare professionals? The Arizona Emergency System for the Advance Registration of Volunteer Health Professionals (AZ-ESAR-VHP) is a secure, Web-based system used to register, qualify and credential Arizona health care professionals before a major public health or medical emergency.