health aide

Phone Number

(347) 625-3190

for Consumers
and Caregivers

CDPAP Forms for New York State: Facilitating Care Access

In navigating the Consumer Directed Personal Assistance Program (CDPAP) in New York State, access to the appropriate forms is paramount for both care receivers and caregivers alike. These forms serve as vital tools in facilitating enrollment, ensuring compliance, and adapting to changing healthcare needs within the program. Carefully curated to address various aspects of the caregiving process, from initial application to ongoing management, each form plays a crucial role in empowering individuals to navigate the complexities of personalized care within the state’s healthcare framework.

Medicaid Consumer:

  • Consumer Application Form:

    • This form is typically filled out by individuals who are seeking personal assistance services through the CDPAP in New York State.
    • It collects essential information about the consumert, including their personal details, medical history, needs assessment, and preferences regarding the caregiver.
    • The form may also include sections for specifying the tasks and hours of assistance required, as well as any specific instructions or special considerations for the caregiver.
  • NYIA and DOH Form (New York Insurance Agency and Department of Health Form):

    • This form is likely a regulatory requirement issued by the New York 
    • Insurance Agency and the Department of Health for individuals participating in the CDPAP.
    • It may include information regarding insurance coverage, liability, and compliance with state regulations governing personal assistance services.
    • The form might cover aspects such as eligibility criteria, documentation requirements, and procedural guidelines for both consumer and caregivers enrolled in the program.
  • MOU Form (Memorandum of Understanding Form):

    • This form outlines the terms and conditions of the agreement between the care recipient (consumer) and the designated caregiver(s) participating in the CDPAP.
    • It establishes the roles, responsibilities, and expectations of both parties involved in the caregiving arrangement.
    • The MOU form may cover topics such as compensation, scheduling, communication protocols, confidentiality agreements, and dispute resolution procedures.
    • Additionally, it may include clauses related to compliance with program regulations, reporting requirements, and termination conditions.

These forms play crucial roles in facilitating the enrollment process, ensuring compliance with regulations, and establishing clear guidelines for the provision of personal assistance services within the framework of the CDPAP in New York State.


  • Personal Assistant Application:

    • This form is completed by individuals interested in becoming caregivers or personal assistants under the CDPAP.
    • It collects personal information, employment history, references, and any relevant qualifications or certifications.
    • The application may also include questions about the applicant’s availability, skills, and experience in providing personal assistance and caregiving services.
  • Driver’s License/NY State ID/Passport:

    • Caregivers are usually required to provide a valid form of identification such as a driver’s license, New York State ID card, or passport.
    • This documentation is essential for verifying the caregiver’s identity and ensuring compliance with legal and regulatory requirements.
  • Social Security Card:

    • Caregivers are typically required to provide a copy of their Social Security card as part of the application process.
    • This documentation is necessary for verifying the caregiver’s eligibility for employment and for processing payroll and tax-related matters.
  • MMR (Measles, Mumps, Rubella) Vaccination Record:

    • Caregivers may be required to provide documentation showing proof of vaccination against measles, mumps, and rubella (MMR).
    • This requirement is aimed at ensuring the safety and well-being of both the caregiver and the consumert by minimizing the risk of contagious diseases.
  • Quantiferon (TB Gold) Test Results:

    • Caregivers may need to undergo testing for tuberculosis (TB) using the Quantiferon Gold test, and provide documentation of the test results.
    • This is a preventive measure to safeguard the health of care recipients, as TB can pose serious risks, especially to individuals with compromised immune systems.
  • Pre-Employment Physical Form:

    • Caregivers may be required to undergo a pre-employment physical examination and provide documentation of the results.
    • The form typically includes assessments of general health, mobility, and fitness to perform caregiving duties safely and effectively.

These forms and documentation ensure that caregivers meet the necessary qualifications, comply with regulatory requirements, and are capable of providing high-quality care to individuals enrolled in the CDPAP in New York State.

Changing Health Plans:

The “Changing Health Plans” form allows consumer or their representatives to request a change in their managed care plan or health insurance provider within the Consumer Directed Personal Assistance Program (CDPAP) in New York State. It collects basic personal information and reasons for the change, facilitating the process of modifying healthcare coverage to better suit the recipient’s needs and preferences.

If you choose to partner with us, we’ll send you a package containing forms for both the caregiver and the care recipient. We’ll also assist you with any paperwork if necessary. If you have any questions, please don’t hesitate to contact us at (347) 625-3190. We’re here to support you every step of the way.