Get Patient Portal My Care Plus

Filling out the Patient Portal My Care Plus User Electronic Mail Authorization Form is a straightforward process that grants you secure access to your health information. This guide will walk you through each section of the form, ensuring you complete it accurately and efficiently.

Follow the steps to fill out the Patient Portal My Care Plus form online.

1. Click the ‘Get Form’ button to obtain the electronic version of the document. This will allow you to access the form in a fillable format.
2. Enter the patient's full name, including the first name, middle initial, and last name, in the designated field. Ensure the spelling is accurate for identification purposes.
3. Provide the email address of the patient or the authorized user. It is important to use an email that the individual can access securely.
4. Fill in the date of birth of the patient in the specified format. This helps verify the identity of the individual accessing the Portal.
5. Write the name of the patient's physician in the corresponding section. This information is necessary for your records.
6. If an authorized user is completing the form, indicate their name in the field provided. This should be done only if the authorized user is different from the patient.
7. Select the appropriate option to identify the relationship of the authorized user to the patient, choosing from: Patient, Patient's Guardian, or Person authorized to make decisions on behalf of the patient.
8. The authorized user must provide their signature in the designated area, confirming their agreement to use the email address listed for this purpose.
9. Include the date of signature, showing when the authorization was completed.
10. After completion, the practice staff will sign and date the form to confirm the identity and authority of the signing person. Keep a copy for your records and proceed to submit the completed form.

Complete the form online to gain secure access to your Patient Portal My Care Plus today.