Release of Information Requests

The forms below are intended for use only by current or previously covered healthcare providers. Questions related to the use and/or completion of the forms should be directed to the SIP Insurance Services team at (352) 273-7006 -or- 844-MY FL SIP, or via email at one of the following addresses:

• University of Florida: ufisosip@mail.ufl.edu
• Florida State University: fsuisosip@mail.ufl.edu
• Florida International University: fiuisosip@mail.ufl.edu
• Florida Atlantic University: fauisosip@mail.ufl.edu
• University of Central Florida: ucfisosip@mail.ufl.edu

Release of Claim and/or Suit Information

	University of Florida Authorization for Release of Information Downloadable / Printable | Electronic
	Florida State University Authorization for Release of Information Downloadable / Printable | Electronic
	University of Central Florida Authorization for Release of Information Downloadable / Printable | Electronic
	Florida International University Authorization for Release of Information Downloadable / Printable | Electronic
	Florida Atlantic University Authorization for Release of Information Downloadable / Printable | Electronic

This webpage, Release of Information Requests, is managed by Lynette Belforti, Operations & Underwriting Officer.

Please feel free to contact her for any questions or recommendations regarding page content.