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APPOINTMENT OF REPRESENTATIVE
The form, OMHA-118, Petition to Obtain Approval of a Fee for Representing a Beneficiary elicits the information required for a fee petition. It should be
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Appointment of Authorized Representative Form
This form lets a UnitedHealthcare Community Plan member choose someone to help or act on their behalf. The top part must be filled out by the member.
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Form 1310 (Rev. August 2014)
A. Surviving spouse requesting reissuance of a refund check (see instructions). B. Court-appointed or certified personal representative (defined below). Attach
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