We are here for you

During this challenging time for our community, HHUNY is still accepting new referrals for our care management program. Our care management agencies are offering support services by phone, text, video visits, and more, and they are implementing a variety of resourceful ways to meet the needs of Members. Click here to make a referral for care management services or call 1-855-613-7659 to obtain assistance by phone. As always, we value and appreciate our community partners!

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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:

Tracy Marchese, HHUNY Community Referral Coordinator
Email: referrals@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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