Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with New York State Department of Health before sending sensitive documents. FaxFlow is not affiliated with this organization.
New York State Department of Health fax number
(646) 640-2802
New York State Department of Health – Office of Long Term Care (OLTC)
Used for: Submit Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services (DOH-4359)
Fax destination details
- Department
- New York State Department of Health – Office of Long Term Care (OLTC)
- Purpose
- Submit Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services (DOH-4359)
- Form
- DOH-4359 — Physician’s Order for Personal Care/Consumer Directed Personal Assistance Services
- Address
- Commissioner Corning Tower Empire State Plaza Albany, NY 12237
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Complete all items; attach additional sheets if necessary; physician must sign and date; form indicates it is based on a medical examination within 30 days; return to the local district or other designated case management entity; fax the completed form to 646-640-2802 within 30 calendar days of examination.
Official form instructions are published as a downloadable file on the organization's website.
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