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1-855-613-7659

Make a Referral

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.

HOW TO MAKE A REFERRAL TO HHUNY

Complete the online form 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

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

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:

HHUNY Community Referral Coordinator
Email: tmarchese@hhuny.org

Fax: 585-613-7670

Mail: Community Referral Coordinator
HHUNY
1099 Jay St, Building J,
Rochester, NY 14611

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)

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

                                                                                                                                                                    

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

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

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

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