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EasyCare EasyCare Plus Total
Appointment of Representative Form

You may appoint a relative, friend, attorney, or anyone else whom you trust to act on your behalf. A representative who is appointed by the court or who is active in accordance with state law may also file an appeal or grievance for you. To appoint a representative you must complete an Appointment of Representative form.

You can give us a copy of the form or letter or mail it to:
VNS Health
Health Plans – Care Team
220 East 42nd Street
New York, NY 10017

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EasyCare EasyCare Plus Total
Authorization for Release of Health Information Form (DOH 5032)
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EasyCare Plus Total EasyCare
Health Information Exchange Fact Sheet and Form
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