Member Forms

Below you will find links to various forms and other documents that VNSNY CHOICE Managed Long Term Care (MLTC) members may need.

Please call Member Services if you need additional information.
(TTY: 711)
 9 am – 5 pm, Monday – Friday

Authorization for Release of Health Information Pursuant to HIPAA (English, Spanish, ChineseRussian)
Health Care Proxy (English, Spanish, Chinese, Russian)

Check below for forms and fact sheets about Health Information Exchanges and Regional Health Information Organizations.

Last updated 6/30/2020

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.