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