MLTC Pre-enrollment Forms

Below you will find links to various forms and other documents that members of VNSNY CHOICE may sometimes have a need for.

Of course, you may call Member Services if you need additional information or support: 
1-888-VNS-6555 
(1-888-866-6555)
(TTY for the hearing impaired: 711)
24 hours a day, 7 days a week
 
MLTC Forms
 
Authorization for Release of Health Information Pursuant to HIPAA (English, Spanish, Chinese, Korean, and Russian)

RHIO Consent - Authorization for Access to Patient/Member Information Through a Health Information Exchange Organization (English, Spanish, Chinese, Russian)
 
Important Information About Member Rights and Responsibilities Booklet
   - Health Information Exchange Fact Sheet
   - Member Bill of Rights and Responsibilities
   - Patient Self-Determination Policies
   - Making Decisions  About Your Medical Care
   - Planning in Advance For Your Medical Treatment
   - Consumer Directed Personal Assistance Statement
 
Health Care Proxy (English, Spanish, Chinese, Korean, and Russian)
 
Notice of Privacy Practices (English, Spanish, Chinese, Korean, and Russian)
 

Find a Provider in Your Area

CHOICE MLTC members can continue seeing their current doctors and do not have to choose from the network. CHOICE uses a network of community providers to deliver many services our MLTC members need. This directory can help you find an MLTC network provider.