|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.