Total Forms and Personal Health Materials
If you have questions or want a printed copy of any of the VNSNY CHOICE Total (HMO D-SNP) materials on this page, please call us at 1-888-783-1444, 7 days a week, 8 am – 8 pm. TTY users should call 711.
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: VNSNY CHOICE Total 220 East 42nd Street, 3rd floor, New York, NY 10017