Make a Referral

HOW TO MAKE A REFERRAL TO ENCOMPASS CHH

The form for submitting a referral to Encompass CHH is below:

Encompass CHH Community Referral Form (link)

You may submit Encompass HH Children’s referrals by SECURELY emailing completed referrals to referrals@hhuny.org or by using the ShareFile folders under Encompass HH.

Please remember CMAs DO NOT ENTER any segments into MAPP.

All referrals and enrollments should be sent to the referral team. Please let them know if you have any questions.

HOW TO MAKE A REFERRAL TO HHUNY

HHUNY is accepting referrals from the community (health care providers, community organizations, individuals and/or family members) for enrollment of eligible individuals into HHUNY Health Home Care Management Services.

Complete one of the online forms below including as much detail as possible to allow HHUNY to verify eligibility for health home care management services.

Self-Referral: If you're submitting a referral on behalf of yourself or a family member

Self Referral

Community Referral: If you're an agency, health care provider or community organization and submitting a referral on behalf of someone in the community

Community Referral

Please click on attachment A to view the list of agencies and organizations that your information may be disclosed to, only when necessary for your referral to be processed.
Attachment A for Central Region
Attachment A for Finger Lakes Region
Attachment A for Southern Tier Region
Attachment A for Western Region

Other Options for Making a Referral to HHUNY

Download the referral and consent form and send via secure e-mail or fax, or mail to:

Tracy Marchese, HHUNY Community Referral Coordinator
Email: referrals@hhuny.org

Fax: 585-613-7670

Mail: Community Referral Coordinator
HHUNY
1150 University Ave, Suite 142A
Rochester, NY 14607
 

Referral forms:

Determine the county you prefer to receive services and download the referral form for the region.  **Fillable referral forms can only be completed in Internet Explorer and Google Chrome.  

Western Region
Community Referral Form (English)
**Fillable Community Referral Form (English)
Community Referral Form (Spanish)
Community Referral Form (Burmese)
Community Referral Form (Karen)

Southern Tier Region
Community Referral Form (English)
**Fillable Community Referral Form (English)
Community Referral Form (Spanish)
Community Referral Form (Burmese)
Community Referral Form (Karen)                                                                                                     

Central Region
Community Referral Form (English)
**Fillable Community Referral Form (English)
Community Referral Form (Spanish)
Community Referral Form (Burmese)
Community Referral Form (Karen)

Finger Lakes Region
Community Referral Form (English)
**Fillable Community Referral Form (English)
Community Referral Form (Spanish)
Community Referral Form (Burmese)
Community Referral Form (Karen)

For more information please call 1-855-613-7659, where you will be offered assistance in completing a referral and consent form.

Submit a question below: