|
Form Details...
| Form Title: | CIGNA Authorization for Use and Disclosure of Private Health Information Form |
| Last Revised: | 04/2003 |
| Purpose: | Employees requesting assistance from Human Resources on specific claims or on claims for a specific period of time. Blanket authorizations are not allowed. |
| Who Should Use the Form: | Employees with the CIGNA insurance medical and/or dental plans. |
| Instructions: | Employee completes the form, signs and submits to Human Resources who then forwards it to CIGNA. |
| The Form: | Form in .pdf format |
If you are having trouble downloading forms see HELP below.
webmaster@fanda.ucar.edu
Thank you!