Get Az Honorhealth Adult Proxy Access Form For Mychart 2018-2025

Completing the AZ HonorHealth Adult Proxy Access Form for MyChart is an essential step for individuals assisting adults with their healthcare management. This guide will provide you with a straightforward and step-by-step approach to filling out the form online, ensuring a smooth experience throughout the process.

Follow the steps to complete the AZ HonorHealth Adult Proxy Access Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the proxy information in the designated section. Fill in the name (last, first, middle initial), date of birth, city, street address, state, phone number, zip code, and email of the individual requesting proxy access. Ensure all sections are completed clearly.
3. Next, move on to the patient’s information section. Again, input details such as the patient’s name (last, first, middle initial), date of birth, gender, street address, city, phone number, email, state, and zip code. Remember that you must fill out all sections accurately and clearly.
4. Review the MyChart terms and agreement summary carefully. Make sure to understand the importance of the information provided, including the limitations and conditions of MyChart access.
5. At the end of the form, the patient must sign to acknowledge their agreement to the proxy access and understanding of the terms. They should also specify the relationship to the patient, along with the date of signing.
6. The proxy will also need to sign the form, indicating their agreement and relationship to the patient, along with the date of signing.
7. Once all sections are completed and signatures are obtained, you can save the changes, download the form, print it out, or share it as needed before mailing or faxing it to the provided address.

Complete your documents online today and ensure seamless access to health information.