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STANFORD HEALTH CARE STANFORD, CALIFORNIA 94305Medical Record Number Patient NameCONSENT ADULT TO MINOR HEALTH PROXY SHARE ACCESS REQUEST FORMAddressograph or Label Patient Name, Medical Record Number
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Step 1: Download the 15-2863-myhealth-child-share-access-request-formpdf from the official website or obtain a physical copy from a relevant authority.
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Step 2: Carefully read the instructions provided on the form to understand the required information and the purpose of the form.
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Step 3: Fill out the form neatly and accurately. Provide all the requested information, including your personal details and the details of the child for whom you are requesting access to health records.
04
Step 4: Attach any necessary supporting documents as mentioned in the instructions. These may include proof of relationship or legal guardianship.
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Anyone who needs access to a child's health records and meets the requirements specified by the form may need 15-2863-myhealth-child-share-access-request-formpdf. This can include parents, legal guardians, healthcare providers, or individuals authorized to make healthcare decisions for the child.
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It is a form used to request access to a child's health information within the MyHealth system.
Parents or guardians of a child who wish to access the child's health information are required to file this form.
To fill out the form, provide the required personal information, the child's information, and specify the type of access being requested.
The purpose of the form is to facilitate the sharing of a child's health information with authorized parents or guardians.
The form requires information such as the child's name, date of birth, and the requesting parent's or guardian's details.
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