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Get Sutter Health Proxy Access Form (children Under 18)
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How to fill out the Sutter Health Proxy Access Form (Children Under 18) online
The Sutter Health Proxy Access Form for Children Under 18 is essential for parents or guardians who wish to access a minor's medical records. This guide will provide you with clear, step-by-step instructions to efficiently complete this form online.
Follow the steps to complete the form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Select your Sutter affiliate or hospital from the provided options. This includes Sutter Medical Foundation, Sutter East Bay Medical Foundation, among others. Make sure to check the appropriate box.
- In the 'Request for Online Access to Medical Records for a Minor Child' section, fill in the patient name details, including last name, first name, and middle initial.
- Provide the phone number, Social Security Number (last four digits only), and date of birth (MM/DD/YYYY) of the minor child.
- Next, enter the proxy representative's details, which include their full name, address, city, state, and ZIP code. Ensure the information is printed legibly.
- Document the proxy representative’s phone number, Social Security Number (last four digits only), and date of birth (MM/DD/YYYY).
- Input the representative's email address and select the relationship to the child from the options provided (Parent, Guardian, Conservator). Note that legal documents may be needed to support this relationship.
- The proxy representative must then sign and date the form in the designated area at the bottom.
- After completing the form, you can save the changes, download, print, or share the completed document.
Submit your Sutter Health Proxy Access Form (Children Under 18) online today to ensure timely access to medical records.
To add a child to the Sutter Health app, you'll need to fill out the Sutter Health Proxy Access Form (Children Under 18). Start by downloading the form from the Sutter Health website or your app account. After filling it out, submit the form, and once approved, you can access your child's health information directly through the app, making it easier to manage their healthcare.
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