Get the free MyChart Incapacitated Adult Proxy Enrollment Form - 8-30-16 Version
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Patient Name: Date of Birth: Adult Proxy for Incapacitated Adult Duke* Chart Access Request (Last revised 83016) Medical Record #: This form should be completed by a person (“Proxy “) who Duke
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How to fill out mychart incapacitated adult proxy
How to fill out mychart incapacitated adult proxy
01
First, go to the MyChart website.
02
Click on the 'Proxy Access' option.
03
Select 'Incapacitated Adult Proxy' from the available options.
04
Provide the necessary information about the adult who is incapacitated.
05
Complete the required forms and documentation.
06
Submit the application for review.
07
Wait for the approval process to be completed.
08
Once approved, you will be granted proxy access to the incapacitated adult's MyChart account.
Who needs mychart incapacitated adult proxy?
01
A person who has been legally designated as the proxy decision-maker for an incapacitated adult may need MyChart incapacitated adult proxy.
02
Individuals who require access to the medical information and records of an incapacitated adult, for legal or healthcare decision-making purposes, would benefit from having MyChart incapacitated adult proxy.
03
Family members, legal guardians, or healthcare providers who are responsible for making healthcare decisions on behalf of an incapacitated adult can benefit from using MyChart incapacitated adult proxy.
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What is mychart incapacitated adult proxy?
MyChart incapacitated adult proxy allows a designated individual to access medical information on behalf of an incapacitated adult.
Who is required to file mychart incapacitated adult proxy?
A legal guardian or designated proxy is required to file MyChart incapacitated adult proxy.
How to fill out mychart incapacitated adult proxy?
To fill out MyChart incapacitated adult proxy, the designated individual must provide their information along with the information of the incapacitated adult.
What is the purpose of mychart incapacitated adult proxy?
The purpose of MyChart incapacitated adult proxy is to allow designated individuals to access and manage medical information for incapacitated adults.
What information must be reported on mychart incapacitated adult proxy?
On MyChart incapacitated adult proxy, the designated individual must report their personal information and information about the incapacitated adult.
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