The HIPAA authorization form can only be completed and signed by the patient ? the college student insured or their spouse or dependent who is at least 18 years of age.

The parents of the college insured cannot complete the authorization form on behalf of the college insured. The form cannot be altered in any way, including text added or deleted. Altered forms or forms not completed and signed by the patient at least 18 years of age will be void.

Please keep a copy for your records.