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

RF employees authorizing health care and health insurance advocacy.

Download the Form

RF Authorization (HIPAA) for Health Care and Insurance
Using Firefox with PDF forms?

Make Adobe Acrobat the reader.

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?

Zachary Jenney.

Zachary Jenney

RF Benefit Services

Phone: 716-645-4439

Email: zjenney@buffalo.edu

Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: xx/xx/2015

Owner: Research Foundation SUNY portal