Loading
Get Upmc Proxy Access
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the UPMC Proxy Access online
Completing the UPMC Proxy Access form is an important step in appointing a proxy to handle health information on your behalf. This guide provides clear and detailed instructions to assist you through each section of the form, ensuring a smooth online experience.
Follow the steps to complete the UPMC Proxy Access form online.
- Click 'Get Form' button to access the UPMC Proxy Access form and open it in your preferred editor.
- Fill in the proxy’s information section, providing their name (last, first, middle initial), gender (select either Female or Male), date of birth, home address, city, state, zip code, home phone number, optional cell phone number, and optional email address. Ensure all fields are completed clearly and accurately.
- In the patient’s information section, verify and enter your personal details, including your name, gender, date of birth, home address, city, state, zip code, phone number(s), and optional email address. Double-check all entries for accuracy.
- Read through the MyUPMC Proxy Terms and Agreement carefully, as it outlines the responsibilities and permissions granted to your proxy. Ensure you fully understand each point before proceeding.
- Sign the form to grant proxy access. Both you and the assigned proxy must provide signatures and dates, confirming your agreement to the terms stated in the form.
- Once the form is complete, save any changes made. You can then download, print, or share the document as needed to submit it to UPMC.
Complete your UPMC Proxy Access form online today for efficient management of your health information.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
To get proxy access on MyChart, sign into your account and select the option for proxy management. You will need to provide some information about the person you wish to proxy for. Once approved, you can securely handle health matters on their behalf using UPMC Proxy Access.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.