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*PROXY ADULT* St. Margaret's Health Medical Records Department 600 E. First Street Spring Valley, IL 61362 Phone: 8156641549 Fax: 8156641169 Mylar Patient Adult Portal Proxy Authorization Please complete
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Proxyadult is a form used to designate an individual to make healthcare decisions on behalf of an incapacitated adult.
Proxyadult is typically filed by family members or close friends of an incapacitated adult.
Proxyadult can be filled out by providing the designated individual's personal information, healthcare preferences, and any specific instructions.
The purpose of proxyadult is to ensure that an incapacitated adult's healthcare decisions are made by a trusted individual.
Information such as the designated individual's contact information, relationship to the incapacitated adult, and healthcare preferences must be reported on proxyadult.
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