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University Health 4502 Medical Drive Medical Records Department, MS# 262 San Antonio, Texas 782294493Phone (210) 3583532Fax (210) 3585936Authorization for Release of Behavioral Health Records I, ___,

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How to fill out adult proxy request and

01

Fill out the adult proxy request form completely

02

Include all required information such as the requester's name and contact information, the adult's name and contact information, and the reason for the request

03

Make sure to sign and date the form before submitting it

Who needs adult proxy request and?

01

Individuals who are unable to make decisions for themselves due to physical or mental incapacity

02

Individuals who are minors and need a legal guardian or adult representative to act on their behalf

03

Individuals who are out of the country and need someone to make decisions for them locally

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What is adult proxy request and?

Adult proxy request is a form filed by an individual who is legally authorized to act on behalf of an adult individual.

Who is required to file adult proxy request and?

An individual who has been granted legal authority to make decisions on behalf of an adult individual is required to file adult proxy request.

How to fill out adult proxy request and?

To fill out adult proxy request, the authorized individual must provide their personal information, the adult individual's information, and details about the authority granted.

What is the purpose of adult proxy request and?

The purpose of adult proxy request is to legally grant decision-making authority to another individual on behalf of an adult individual who may be unable to make decisions themselves.

What information must be reported on adult proxy request and?

The information that must be reported on adult proxy request includes personal details of the authorized individual, details about the authority granted, and the adult individual's information.

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