Get Personal Representative Designation - Osf Myhealth - Osfmyhealth

Designating a personal representative is an important step in managing your healthcare information. This guide will assist you in filling out the Personal Representative Designation form for OSF MyHealth online, ensuring your preferences are clearly communicated.

Follow the steps to successfully complete your designation form.

1. Click 'Get Form' button to obtain the form and access it for editing.
2. Enter your personal information in the designated fields. Provide your full name as the patient and your date of birth accurately to ensure proper identification.
3. Specify the date of your request in the appropriate field. Additionally, if you have a specific date or event when this designation will become invalid, note that information; if left blank, it will remain effective until revoked in writing.
4. List the person(s) you wish to designate as your personal representative. For each individual, fill out their full name, relationship to you, and their phone number. Make sure to accurately provide this information to avoid any issues with communication.
5. Indicate the types of information you wish to be disclosed to your personal representative(s). Check all that apply from the list provided, including appointments, test results, diagnosis, medications, referrals, and billing.
6. If there is any other specific information you would like disclosed, write it in the space provided. This ensures your personal representative(s) have access to all relevant information.
7. Finally, sign the form. The signature must be that of the individual or another person authorized to act on your behalf. Include the date of your signature.
8. Once you have filled out the form, you can save your changes. Ensure to download, print, or share the form as necessary to keep a copy for your records.

Complete your Personal Representative Designation form online today to ensure your healthcare preferences are known.