Community Referral For Health Home Care Management Services Page 5

CONSENT TO DISCLOSE HEALTH RECORDS – ATTACHMENT A

HHUNY WESTERN

Health information may be disclosed for purposes of treatment to the people and organizations listed below.

- Buffalo Federation of Neighborhood Centers

- New York State Office of Mental Health

- Buffalo Psychiatric Center

- New York State Office of Alcohol and Substance

Abuse Services

- Community Concerns of WNY, Inc.

- Transitional Services, Inc.

- Coordinated Care Services, Inc.

- United Healthcare

- Evergreen Health Services

- Venture Forthe, Inc.

- HealthNow New York, Inc.

- Western New York Independent Living, Inc.

- Hillside Family of Agencies

- YourCare Health Plan

- Independent Health Association, Inc.

- Jericho Road Community Health Center

- Lake Shore Behavioral Health, Inc. aka Lake

Shore Health Home Services

- Monroe Plan for Medical Care

- New York Care Coordination Program, Inc.

- New York State Catholic Health Plan dba Fidelis

Care New York

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Parent category: Medical