Register for Camp

Forms – Jacksonville State University

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

 

*You can submit the form online by signing in to My Account.

 

Forms – University of North Alabama

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

Forms – United Christian Academy

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

Forms – Kettering College

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

 

*You can submit the form online by signing in to My Account.

 

Forms – Webster University

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

Forms – California State University- Bakersfield

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

 

*You can submit the form online by signing in to My Account.

 

Forms – St. John’s University

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

 

*You can submit the form online by signing in to My Account.

 

Forms – Virginia Commonwealth University

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

Forms – Andrews Osborne Academy

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

 

Forms – Eurasia

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 

Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 

Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

 

*You can submit the form online by signing in to My Account.