Get Request And Authorization To Access Backus Hospital39s Patient Portal

Accessing your health information is essential for managing your well-being. This guide provides step-by-step instructions on how to complete the Request And Authorization To Access Backus Hospital's Patient Portal online, ensuring you can connect with your medical data easily and securely.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the Request And Authorization form and open it in your preferred editing tool.
2. Start by filling in your personal details. Enter the patient's full name, and if the patient is a minor, provide the parent's name. Then, include the patient's date of birth, address, and telephone number.
3. Indicate who you are authorizing to access your health information. If you are the patient, check the box for 'Self (Patient/Authorized Representative)' and provide your email address. If you are designating another individual, check the corresponding box and complete their name, address, email, and telephone number.
4. Read through the authorization section carefully. This outlines the implications of granting access to your health information. Make sure you understand the scope of your authorization, especially regarding sensitive information and how it may be disclosed.
5. Sign the form at the bottom, providing your signature and the date. If you are a legal representative, include your printed name and your relationship to the patient. Remember, legal documentation for authorized representatives is necessary.
6. Review the completed form for accuracy. Once satisfied, save any changes made to the document.
7. You can then download, print, or share the completed form as needed.

Take control of your health information today by completing the Request And Authorization To Access Backus Hospital's Patient Portal online.