Order - Qualified Medical Child Support Order (Non-IV-D Cases)
New York Family Court · Family Law
Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗
Qualified medical child support order under Family Court Act §416 and Domestic Relations Law §240 directing a parent's employer health plan to enroll the child, in a support case not handled by the child support agency.
This form must be printed and filled by hand, or opened in Adobe Acrobat.