Member 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:
 
1-866-469-7774
(TTY: 711)
Monday – Friday, 8 am – 6 pm
 
SelectHealth Forms
Authorization for Release of Health Information and Confidential HIV Related Info:
English         Spanish
 
RHIO Consent 
Check below for forms and fact sheets about Health Information Exchanges and Regional Health Information Organizations.

Authorization for Access to Patient/Member Information Through a Health Information Exchange Organization 
English        Spanish

Health Information Exchange Fact Sheet
English        Spanish
 
Additional Information
Notice of Privacy Practices:     
English        Spanish

Last updated 5/4/2017

 

Find a Doctor in Your Area

Use this simple search tool to locate primary care and other physicians with offices near where you live.