Ny Medicaid Choice Authorized Representative Form - Web result complete and sign this form to name a person as your authorized representative with new york. Ny state of health, po box. I, (print name), designate the person. Web result the authorized representative can apply for and/or renew medicaid for the consumer, discuss the. Web result authorized representative forms and accompanying documentation can be sent to: Web result medicaid authorized representative designation/change request.
Web result medicaid authorized representative designation/change request. Web result authorized representative forms and accompanying documentation can be sent to: Ny state of health, po box. I, (print name), designate the person. Web result complete and sign this form to name a person as your authorized representative with new york. Web result the authorized representative can apply for and/or renew medicaid for the consumer, discuss the.