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Get My ClinicChart Proxy Access BFormb - Avera - Avera

Proxy Access Form My ClinicChart Access to a patients Prime Patient Chart Record To request access to the Family Medicine Clinic My Clinic Chart account of a patient whose medical care the proxy (someone.

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  3. Complete the blank fields; concerned parties names, addresses and numbers etc.
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  5. Add the particular date and place your e-signature.
  6. Simply click Done following twice-checking everything.
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