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East field House Surgery Line Access for ProxyInformation Leaflet & Application Formulas retain pages 1 & 2 for your future reference. If you want to apply for online access to your medical records,
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How to fill out proxy access adult patients

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How to fill out proxy access formadult patients

01
Fill out the proxy access form with the patient's personal information.
02
Provide your own personal information as the proxy.
03
Sign and date the form where indicated.

Who needs proxy access formadult patients?

01
Adult patients who are unable to access or manage their own medical information.
02
Adult patients who require assistance with communicating their medical needs to healthcare providers.

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The proxy access form for adult patients is a document that allows an individual (the proxy) to access the medical information of an adult patient, typically for purposes of assisting in their healthcare decisions.
Typically, the adult patient is required to file the proxy access form to grant permission for another individual to access their medical information.
To fill out the proxy access form, the adult patient must provide their personal information, the proxy's details, and specify the extent of access being granted, then sign and date the form.
The purpose of the proxy access form is to ensure that designated individuals can help manage and make decisions regarding a patient's healthcare by accessing their medical records and information.
The proxy access form must report the adult patient's name, date of birth, the name and contact information of the proxy, and the specific permissions being granted.
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