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Referral Form Patient Full Name: ___ Date of Birth: ___ (Please ensure the name is spelled correctly)Legal Guardian/Parent Name: ___ Phone Number: ___THE SECTION BELOW IS OPTIONALReason for Referral:
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How to fill out my health portal proxy
How to fill out my health portal proxy
01
Log in to your health portal account.
02
Navigate to the section for proxy access or sharing.
03
Add the email address of the person you want to grant proxy access to.
04
Specify the level of access or permissions you want to grant to the proxy.
05
Review and submit the request to finalize the process.
Who needs my health portal proxy?
01
Individuals who want to allow a trusted family member or caregiver to access their health information and make decisions on their behalf.
02
Patients who may not be able to manage their health portal on their own due to age, illness, or disability.
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What is my health portal proxy?
A health portal proxy is a person or entity that is authorized to access your health information on your behalf.
Who is required to file my health portal proxy?
You are required to file your health portal proxy, typically with your healthcare provider or insurance company.
How to fill out my health portal proxy?
You can fill out your health portal proxy by providing the necessary information, such as your name, contact information, and the name of the person or entity you are authorizing to access your health information.
What is the purpose of my health portal proxy?
The purpose of a health portal proxy is to allow someone else to access your health information and communicate with your healthcare providers on your behalf.
What information must be reported on my health portal proxy?
Your health portal proxy should include your personal information, the name of the person or entity being authorized, and any specific limitations or restrictions on their access.
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