Forms
Looking for more in-depth information about your VNS Health plan? You’ll find it here, along with forms and other tools and materials.
If you have questions about any of the materials listed here, please call us at 1-888-783-1444 (EacyCare, EasyCare Plus and Total Members), weekdays, 8 am-8 pm or call us at 1-866-414-6715 (MLTC Members) (TTY: 711) weekdays, 8 am-8 pm. TTY users should call 711.
Forms and Personal Health Materials
CDPAS Recertification – Physician Order Form
Health Care Proxy
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
If you’d like to request a printed copy of any of the following materials, please call your Care Team at the number below or email us at [email protected].