Provided below are the necessary forms for consumers to get started with CDPAP. Please print out and complete the forms following the order suggested below.
If you need help with anything, please call us at (718) 831-2900.
Please Note: Edison Home Health Care is a Fiscal Intermediary for CDPAP. We do not administer the program. We can help you navigate, but application and enrollment for CDPAP must go through your Local Department of Social Services or Medicaid plan.
Click the button below to download a 1 page outline explaining the 3 basic parts of enrolling in CDPAP.
Want to learn if you qualify for CDPAP? Click the button below to get instant feedback on your eligibility!
- DOH Form – Physician’s Order (for Consumer)
- Your Doctor must confirm that you, the consumer, are authorized to receive services.
- This form is 100% Mandatory – Your doctor MUST fill out this form.
Changing Health Plans
- PCP Transfer Form (for Consumer)
- Consumer needs this form filled out by their Doctor to transfer from their current plan to any other type of health care plan.
- CDPAP Welcome Package (for Consumer)
- General information for the consumer including rules and guidelines for CDPAP. Take a look to learn more about your rights as a consumer and what type of coverage is included in CDPAP.