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Get Osf Healthcare Adult Proxy Form 2011-2025
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How to fill out the OSF HealthCare Adult Proxy Form online
This guide provides a clear, step-by-step approach to completing the OSF HealthCare Adult Proxy Form online. By following these instructions, you will easily navigate the form and establish the necessary authorization for accessing an adult's OSF myHealth account.
Follow the steps to fill out the OSF HealthCare Adult Proxy Form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the Patient Information section. Enter the patient's name (last, first, middle initial), date of birth, street address, phone number, city, state, zip code, and email address. Ensure all information is clear and accurate.
- Next, complete the Proxy Information section. Fill in the proxy's name (last, first, middle initial), date of birth, street address, phone number, city, state, zip code, and email address, ensuring all fields are filled as per the instructions.
- Review the OSF myHealth Terms and Agreement carefully. Confirm your understanding by signing and dating the designated area, which acknowledges your agreement to the terms outlined.
- Proceed to the Adult OSF myHealth Proxy Authorization for Release of Medical Information section. The patient must print their name, date of birth, and provide details regarding the proxy, including their name and date of birth, ensuring the proxy is involved in the patient's care.
- Complete the Authorization for Release of Mental Health / Developmental Disability Information section, if applicable, by filling in the necessary details about the information to be disclosed. This information must reflect the proxy designated by the patient.
- Finally, review all sections for accuracy and completeness. Once confirmed, you can save changes, download the form for printing, or submit it as required by your OSF Physician's Office.
Start filling out the OSF HealthCare Adult Proxy Form online today to ensure access to important medical information.
Related links form
To grant proxy access in MyChart, log into your account and find the 'Proxy Access' section. You will need to submit an OSF HealthCare Adult Proxy Form, which authorizes another person to access your information. After completing the form and submitting it, your proxy should be able to manage your account effectively.
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