HIPAA Authorization for Health Care and Insurance For Research Foundation (RF)

RF employees authorizing health care and health insurance advocacy.

Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

Research Foundation Human Resources
120 Crofts Hall
llNorth Campus

Need help completing the form?

Send email, phone or submit a question

Zachary Jenney

RF Benefit Services

Phone: 716-645-4439

Email: zjenney@buffalo.edu

 
 
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Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: xx/xx/2015

Owner: Research Foundation SUNY portal