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HAWAII REGION:KP.org ACT FOR A FAMILY MEMBER PROXY ACCESS MINOR Recordable: DOB:Original: 07/2016Revised: 02/20/2020Please complete this form if: You are the parent or guardian of a minor who is

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How to fill out act-for-family-member-proxy-access-minor-record-hi-enpdf

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Open the act-for-family-member-proxy-access-minor-record-hi-enpdf file using a PDF reader.

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Review the instructions and information provided in the document.

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Locate the necessary sections to be filled out, such as personal information, proxy access details, and minor record information.

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Who needs act-for-family-member-proxy-access-minor-record-hi-enpdf?

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Individuals who require proxy access to a minor's record in Hawaii.

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What is act-for-family-member-proxy-access-minor-record-hi-enpdf?

The act-for-family-member-proxy-access-minor-record-hi-enpdf is a document that allows designated individuals to access the health records of a minor on behalf of the minor's family.

Who is required to file act-for-family-member-proxy-access-minor-record-hi-enpdf?

Parents or legal guardians of a minor are required to file the act-for-family-member-proxy-access-minor-record-hi-enpdf to grant proxy access to another individual.

How to fill out act-for-family-member-proxy-access-minor-record-hi-enpdf?

To fill out the act-for-family-member-proxy-access-minor-record-hi-enpdf, download the form, complete the required fields including the minor's details, the designated proxy's information, and provide necessary signatures.

What is the purpose of act-for-family-member-proxy-access-minor-record-hi-enpdf?

The purpose of the act-for-family-member-proxy-access-minor-record-hi-enpdf is to allow a specified adult to manage and access a minor's health information for medical decisions and care coordination.

What information must be reported on act-for-family-member-proxy-access-minor-record-hi-enpdf?

The act-for-family-member-proxy-access-minor-record-hi-enpdf must include the minor's full name, date of birth, the proxy's full name, relationship to the minor, and signature of the parent or legal guardian.

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