Making a Referral to CHHUNY
The Children’s Health Home of Upstate New York (CHHUNY) is accepting referrals from the community (community organizations, individuals and/or family members) for enrollment of eligible children/youth into Health Home Care Management Services. Children/youth must meet all eligibility requirements to be considered for enrollment.
DOWNLOAD THE CHHUNY REFERRAL FORM FOR HEALTH HOME CARE MANAGEMENT SERVICES FORM HERE (.pdf)
This form can be completed and saved electronically
1. Complete the Community Referral Application Form that is linked above, including as much detail as possible to allow CHHUNY to verify eligibility for health home care management services.
If you believe the child/youth has complex trauma, the Complex Trauma Referral Cover Sheet and the Complex Trauma Exposure Screen available from the DOH website must also be completed and attached with the CHHUNY referral form.
2. You may return the completed Application directly to a CHHUNY Care Management Agency, or to CHHUNY via secure e-mail, fax, or mail:
Mail: CHHUNY Community Referral Coordinators
Health Homes of Upstate New York
1099 Jay Street, Bldg. J, 3rd floor
Rochester, NY 14611
Approved children/youth will be assigned to a Care Management Agency who will conduct outreach and attempt to engage the child/youth in health home care management services. Health Home services are voluntary and the youth and/or parent/guardian will be asked to consent during the outreach and engagement process.
If you have questions regarding the completion or status of this application, please contact: CHHUNY Community Referral Coordinator at 855-209-1142.