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Northwell Health Proxy Request and Authorization Form for Access to
access Patient Portal Minor Consent (Under 13)
If you are the parent or legal guardian of a Northwell Health patient who is under
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How to fill out nslij minor fmh proxy
How to fill out nslij minor fmh proxy
01
Obtain the NSLIJ minor FMH proxy form from the official website or hospital.
02
Fill out the patient's information including name, date of birth, and medical record number.
03
Provide the parent or guardian's information including name, relationship to patient, contact information, and signature.
04
Specify the conditions under which the proxy can make decisions on behalf of the patient.
05
Have the form notarized by a licensed notary public if required.
Who needs nslij minor fmh proxy?
01
Parents or guardians of minors who may need to make medical decisions on behalf of the minor while at NSLIJ.
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What is nslij minor fmh proxy?
NSLIJ Minor FMH Proxy stands for North Shore-LIJ Health System Minor Family Health Proxy. It is a legal document that allows a parent or guardian to appoint another adult to make medical decisions for their minor child in case the parent or guardian is unavailable or incapacitated.
Who is required to file nslij minor fmh proxy?
Parents or legal guardians of minor children are required to file NSLIJ Minor FMH Proxy.
How to fill out nslij minor fmh proxy?
To fill out NSLIJ Minor FMH Proxy, one must provide information about the appointed proxy, the minor child, and sign the document in the presence of witnesses.
What is the purpose of nslij minor fmh proxy?
The purpose of NSLIJ Minor FMH Proxy is to ensure that there is a designated person who can make medical decisions for a minor child when the parent or guardian is unable to do so.
What information must be reported on nslij minor fmh proxy?
Information such as the proxy's name, relationship to the minor child, contact information, and specific instructions regarding medical decisions must be reported on NSLIJ Minor FMH Proxy.
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