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Are You in Need of Home Health Care Services In New York?
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New York
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Upstate NY Home Care
Michigan
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About Us
FAQ’s
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Home Care
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Private Pay
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NHTD
NHTD
TBI
Work For Rockaway
Work With Rockaway
Employee Links
Keeper
Employee Referral Program
Forms
FSA Card(Melody)
Maxsip Phone Partnership
Get Verified
DME
Contact
Choose Your State
New York
CDPAP
Downstate NY Home Care
Upstate NY Home Care
Michigan
Missouri
About Us
About Us
FAQ’s
Blog
Home Care
Home Care
Medicaid Planning
Private Pay
Pediatrics
CDPAP
NHTD
NHTD
TBI
Work For Rockaway
Work With Rockaway
Employee Links
Keeper
Employee Referral Program
Forms
FSA Card(Melody)
Maxsip Phone Partnership
Get Verified
DME
Contact
516-239-8693
All The Forms You Need In One Place
Timesheets
Submit Timesheets
Annual Health Assessment
letterhead
Medical Forms
Download Form
Download CDPAP Medical
Upload Medical Forms
vaccination
Flu Shot or Declination
Download Declination Form
Submit Declination
TB Screen
Additional Forms
Direct Deposit Form
Upload Doctor Results
Submit Direct Deposit
Work Forms
Download W4 Form
Download IT-2104
How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Signup For NHTD
Signup for Private Pay
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland County
Suffolk County
Nassau County
Westchester County
Dutchess County
Orange County
Putnam County
Ulster County
Sullivan County
Are You?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
CDPAP - I have a family member I want to care for
Looking for training
Are You The?
(Required)
Patient
Family
Friend
Other
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
What Is The Patients Medicaid Number?
Medicaid numbers should be in AB12345C format.
One MUST have MEDICAID to enroll in the CDPAP, NHTD And Homecare programs. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP, NHTD or Homecare programs WITHOUT MEDICAID
Privacy Policy
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
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How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Signup For NHTD
Signup for Private Pay
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland County
Suffolk County
Nassau County
Westchester County
Dutchess County
Orange County
Putnam County
Ulster County
Sullivan County
Are You?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
CDPAP - I have a family member I want to care for
Looking for training
Are You The?
(Required)
Patient
Family
Friend
Other
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
What Is The Patients Medicaid Number?
Medicaid numbers should be in AB12345C format.
One MUST have MEDICAID to enroll in the CDPAP, NHTD And Homecare programs. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP, NHTD or Homecare programs WITHOUT MEDICAID
Privacy Policy
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
CAPTCHA
This field is hidden when viewing the form
utm_source
This field is hidden when viewing the form
utm_medium
This field is hidden when viewing the form
utm_campaign
This field is hidden when viewing the form
utm_term
This field is hidden when viewing the form
utm_content
This field is hidden when viewing the form
gclid
Comments
This field is for validation purposes and should be left unchanged.
