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:         

Human Resources
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

Attn. Research Foundation Human Resources

Need Help Completing the Form?

Zachary Jenney.

Zachary Jenney

Research Foundation 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