Forms & Resources
Note: All MVP forms and publications are PDF files.
Adobe Acrobat Reader is required to view PDF files. This is a free program available from the Adobe website.
Follow the download directions on the Adobe website to get your copy of Adobe Acrobat Reader.
Claims & Reimbursement Forms
Wellness Rewards Screening Form
Medical Reimbursement Form
Routine Eye Glasses/Contact Lens Reimbursement Form
Post-Cataract Eyewear Reimbursement Form
Dental Claim Form
Hearing Aid Reimbursement Form
Flu Shot Reimbursement Form
Advance Directives/Advance Care Planning
New York Advance Directives - What You Need to Know
NYSBA Living Will and Health Care Proxy Forms
New York State Department of Health
Organ and Tissue Donations
Medical Orders for Life Sustaining Treatment (MOLST)
Vermont Department of Health
Vermont Advance Directive for Health Care
Medicare.gov (U.S. Government site for Medicare)
Medicare Complaint Form
National Coverage Determinations from CMS
U.S. Social Security Administration
U.S. Department of Health and Human Services
New York State EPIC Program
New York State Office for the Aging
The Coalition for Medicare Choices
More Forms and Resources
Many forms and publications, such as enrollment forms and your Living Well Newsletter, depend on where you live. Select your county and then click on Forms and Resources on the top of the following webpage.
Last updated: October 2017