Total Forms and Personal Health 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 – Care Team 220 East 42nd StreetNew York, NY 10017