Get the free SLU MYCHART Adult Proxy Form.DOCX. 00023517-1 - slu
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Chart Adult Proxy Form
Access to Another Adults Chart Record
To request access to the Chart record of an adult whose medical care you help manage, please complete
this form. The patient must sign
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How to fill out slu mychart adult proxy
How to fill out slu mychart adult proxy:
01
Visit the SLU MyChart website: Go to the official website of SLU MyChart. You can search for it on your preferred search engine or directly enter the relevant URL into your web browser.
02
Log in to your SLU MyChart account: If you already have an account, enter your login credentials (username and password) to access your account. If you don't have an account, create one by following the instructions provided on the website.
03
Navigate to the "Forms" or "Proxy Access" section: Look for a tab, link, or menu option that allows you to access the appropriate forms or proxy access settings. It may be labeled as "Forms," "Proxy Access," or something similar.
04
Locate the adult proxy form: Within the Forms or Proxy Access section, search for the adult proxy form. It may be specifically labeled as "SLU MyChart Adult Proxy Form" or something similar.
05
Download or access the form: Once you have found the adult proxy form, click on it to download or access it directly on the SLU MyChart website. The form is typically provided in a PDF or printable format.
06
Fill out the form: Print out the downloaded form or fill it out electronically if provided with that option. The form will require you to provide certain information such as your name, date of birth, relationship to the adult, and their identifying information.
07
Obtain required signatures: After filling out the form, make sure to obtain the required signatures. The adult whose information you are accessing through the proxy may need to sign the form, along with their expressed consent.
08
Submit the form: Once the form is complete and signed, follow the instructions provided on the form or the SLU MyChart website to submit it. This may involve mailing the form or submitting it electronically through the SLU MyChart platform.
Who needs SLU MyChart adult proxy:
01
Family members: Family members who have been authorized by the adult can use the adult proxy to access their medical information on SLU MyChart. This can include parents, spouses, or adult children.
02
Caregivers: Caregivers who are responsible for the health and well-being of the adult can also benefit from having access to their medical information through the SLU MyChart adult proxy. This can include individuals providing home care, medical assistance, or support services.
03
Legal representatives: In some cases, legal representatives of the adult may require access to their medical information. This can include attorneys, guardians, or anyone legally authorized to act on behalf of the adult.
It is important to note that access to someone's medical information through the SLU MyChart adult proxy should only be granted with the explicit consent of the adult and in compliance with applicable privacy and confidentiality laws.
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What is slu mychart adult proxy?
Slu MyChart adult proxy is a feature that allows a designated individual to access medical records and communicate on behalf of an adult patient.
Who is required to file slu mychart adult proxy?
A designated individual, selected by the adult patient, is required to file slu mychart adult proxy.
How to fill out slu mychart adult proxy?
To fill out slu mychart adult proxy, the designated individual must provide their information and sign an authorization form.
What is the purpose of slu mychart adult proxy?
The purpose of slu mychart adult proxy is to allow a designated individual to access and manage the medical information of an adult patient.
What information must be reported on slu mychart adult proxy?
The slu mychart adult proxy must include the designated individual's identification, contact information, and relationship to the adult patient.
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