Skip to main content

An Official Vermont Government Website

Agency of Human Services Department of Vermont Health Access

Home
About Us
Administration
Advisory Committees and Boards
Apply for Health Insurance and Member Resources
Budget, Reports, Rules and Regulatory Info
MMIS Department Initiatives
Forms and Manuals
Provider Resources and Clinical Programs
Quality, Outcomes, Customer Satisfaction
Stay Informed and Protect Your Health
DVHA Procedures and Guidance Documents

Search

Learn about how Medicaid coverage for diabetes supplies is changing.

Home
About Us
Administration
Advisory Committees and Boards
Apply for Health Insurance and Member Resources
Budget, Reports, Rules and Regulatory Info
MMIS Department Initiatives
Forms and Manuals
Provider Resources and Clinical Programs
Quality, Outcomes, Customer Satisfaction
Stay Informed and Protect Your Health
DVHA Procedures and Guidance Documents

Physician Referral Form

File

VPTA PRF Physician Referral Additional Request Form 2022 rev9.1.22.pdf (218.76 KB)

File Format

Department of Vermont Health Access

280 State Drive, NOB 1 South
Waterbury, Vermont 05671-1010
Phone: 802-879-5900
Fax: 802-241-0260
For Telecommunications Relay Service: Dial 711

Questions about your health coverage?
Call Customer Service: 1-855-899-9600

Department Contact List for customer service, program telephone and fax numbers, and staff email

Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm

Media Requests
Alex McCracken
Director of Communications and Legislative Affairs
Alex.Mccracken@vermont.gov

Public Record Requests
Jessica Ploesser
Department of Vermont Health Access
Jessica.Ploesser@vermont.gov
Visit the Agency of Administration site for the Public Records Database

Quick Links

Agency of Human Services (AHS)
Department for Children and Families (DCF)
Department of Disabilities, Aging and Independent Living (DAIL)
Department of Mental Health (DMH)
Vermont Department of Health (VDH)
Department of Human Resources Career Site

Language Assistance Services

नेपाली

Srpsko-hrvatski

ภาษาไทย

Report Medicaid Fraud, Waste, and Abuse

Return to top

Copyright © 2025 State of Vermont All rights reserved. |

Policies
Accessibility Policy
Privacy Policy
Feedback Survey