Personal Care Services

Personal Care Services benefits have been added to the Medicaid managed care benefit effective 8/1/11. Below are some of the forms required to be completed.

For new referrals, physicians will need to fax the completed order form to Fidelis Care at 1-877-882-5875  before an in-home assessment can be scheduled.

Personal Care Benefit Physician's order form (Outside of New York City) DOH 4359 (2010) (.pdf)

Personal Care Benefit Physician's request form (New York City) Form M-11q (12/2014) (.pdf)