Get Adult Proxy Form Osf Mychart Is A Service Provided By Osf Healthcare System

This guide provides clear instructions on how to complete the Adult Proxy Form for OSF MyChart, a service provided by OSF Healthcare System. By following these steps, you will be able to grant another adult access to your MyChart account securely and efficiently.

Follow the steps to complete the Adult Proxy Form accurately.

1. Press the ‘Get Form’ button to obtain the Adult Proxy Form. This will open the document for you to fill out.
2. Begin by entering the patient's information in the designated fields. Make sure to print clearly and include the patient's full name (last, first, middle initial), the last four digits of their Social Security Number, date of birth, gender, street address, city, state, zip code, and the provider’s name or office if applicable.
3. Next, move on to the proxy information section. Fill out the proxy’s full name, last four digits of their Social Security Number, date of birth, gender, phone number, street address, city, state, zip code, and email address.
4. Review the OSF MyChart Terms and Agreement carefully. Make sure you understand the responsibilities involved with accessing another adult’s medical information and select a secure password if necessary.
5. Have the patient sign the form, indicating their agreement to the terms. They will also need to include their relationship to the proxy and the date of signing.
6. The proxy must also provide their signature, relationship to the patient, and the date, acknowledging that they have read and understand the agreement.
7. Once all required fields are completed and signatures are obtained, save the changes. You can then download, print, or share the completed form as needed.

Complete your Adult Proxy Form online today to ensure seamless communication regarding medical care.