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ANDREW M. CUOMO GovernorHOWARD A. TUCKER, M.D., J.D. CommissionerSALLY DRESSING, M.S., R.N. Executive Deputy CommissionerHealth Home Consent Frequently Asked Questions (FAQ) For Use with Children
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How to fill out health home consent

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How to fill out health home consent

01
Step 1: Obtain a health home consent form from your healthcare provider or health home program.
02
Step 2: Read the consent form carefully and understand the information provided.
03
Step 3: Fill out your personal details such as your name, date of birth, address, and contact information.
04
Step 4: Specify your healthcare provider or health home program's details, such as their name, address, and contact information.
05
Step 5: Indicate your consent by signing and dating the form.
06
Step 6: Review the completed form to ensure all information is accurate and complete.
07
Step 7: Submit the signed consent form to your healthcare provider or health home program.
08
Step 8: Keep a copy of the consent form for your records.

Who needs health home consent?

01
Individuals who wish to participate in a health home program.
02
Individuals who are seeking comprehensive care coordination and management services.
03
Individuals with chronic or complex medical conditions, mental health disorders, or substance abuse issues.
04
Individuals who may benefit from having a designated care manager who can help coordinate their healthcare services.
05
Individuals who are eligible and enrolled in a health home program as determined by their healthcare provider or insurance plan.
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Health home consent is a document that allows healthcare providers to share and receive information about a patient's medical history and treatment.
Healthcare providers and organizations participating in a patient's care are required to file health home consent.
Health home consent can be filled out by providing the necessary personal and medical information of the patient and signing the document.
The purpose of health home consent is to ensure that healthcare providers have access to all relevant information to provide effective and coordinated care for the patient.
Information on a patient's medical history, current medications, and treatment plans must be reported on health home consent.
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