Total Forms and Personal Health Materials
Looking for more in-depth information about your VNS Health Total (HMO D-SNP) plan? You’ll find it here, along with forms and other tools and materials.
CDPAS Recertification – Physician Order Form
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 – Total 220 East 42nd Street, New York, NY 10017