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 Access to Patient/Member Information Through a Health Information Exchange Organization (EnglishSpanishChineseRussian)

Authorization for Release of Health Information Pursuant to HIPAA (English, Spanish, ChineseRussian)
Health Care Proxy (English, Spanish, Chinese, Russian)
Last updated 10/9/2019

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.