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Patient/Resident Portal Revoke Proxy Authorization FormEmail completed form to PatientPortalSupport@brooksrehab.org PATIENT/RESIDENT INFORMATION Patient/Resident Name:___Medical Record Number # ___Address:___Last

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How to fill out patientresident portal revoke proxy

01

Log in to the patient/resident portal.

02

Navigate to the settings or account section.

03

Find the option for revoking proxy access.

04

Select the individual or entity from whom you wish to revoke proxy access.

05

Confirm the action and save the changes.

Who needs patientresident portal revoke proxy?

01

Patients or residents who have granted proxy access to another individual or entity and wish to revoke it.

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What is patientresident portal revoke proxy?

The patientresident portal revoke proxy is a document used to formally cancel or revoke the authority granted to a proxy or representative to access a patient's medical information or make healthcare decisions on their behalf.

Who is required to file patientresident portal revoke proxy?

Any patient or resident who has previously granted proxy access and wishes to terminate that access is required to file a patientresident portal revoke proxy.

How to fill out patientresident portal revoke proxy?

To fill out the patientresident portal revoke proxy, the individual must provide their personal information, details of the proxy being revoked, and sign the document to confirm the revocation.

What is the purpose of patientresident portal revoke proxy?

The purpose of the patientresident portal revoke proxy is to ensure that individuals have control over who can access their medical information and make healthcare decisions, allowing them to remove or change their authorized representatives as needed.

What information must be reported on patientresident portal revoke proxy?

The information that must be reported includes the patient's name, the name of the revoked proxy, the date of revocation, and any relevant identification numbers or account details.

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