Adult HCBS Referral form is completed by a Care Manager. A Plan of Care and Insurance authorization must accompany this form before services begin.

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Anyone can refer to Southern Tier Transformation Plan. Recipients of service must be Adults residing in Chemung, Ontario, Schuyler, Seneca, Steuben, Tompkins, Wayne and Yates county.

Referrals can be emailed, faxed or mailed to AHNY.

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Anyone residing in Wayne, Ontario, Seneca, Yates, Schuyler, Steuben, Chemung, Tioga and Allegany counties can receive AHNY county based Family Support Services. 

Fill out this referral and email, mail or fax to AHNY.

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Anyone can complete a CFTSS referral. The Referral should be completed and emailed, faxed or mailed to AHNY. Services however cannot begin without a medical recommendation from a Licensed Practitioner of the Healing Arts (LPHA)

DOWNLOAD CFTSS Referral Form

DOWNLOAD CFTSS Medical Recommendation