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MY HEALTH PORTAL PROXY ACCESS REQUEST AND AUTHORIZATION FORM For help with this form, please contact the Patient Portal Help Desk at 509.769.2025Patient Information Patient Name ___ Date of Birth
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How to fill out my health portal proxy

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How to fill out my health portal proxy

01
Log in to your health portal using your username and password.
02
Look for the section where you can designate a proxy.
03
Enter the name and contact information of the person you wish to designate as your proxy.
04
Specify the level of access and permissions you want to grant to your proxy.
05
Review the information for accuracy and submit the form.

Who needs my health portal proxy?

01
Individuals who may need assistance managing their healthcare, such as elderly individuals or those with disabilities.
02
Patients who want a trusted individual to access their health information and make decisions on their behalf.
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A health portal proxy is a legal document that allows an individual to designate another person to access their health information and make healthcare decisions on their behalf.
Individuals who wish to appoint someone else to handle their health information and decisions must file a health portal proxy.
To fill out a health portal proxy, you generally need to provide your personal information, the information of the person you are designating as your proxy, and any specific instructions or limitations you want to include.
The purpose of a health portal proxy is to ensure that someone you trust can make medical decisions for you and access your health information if you are unable to do so yourself.
Typically, the information required includes your name, the name of your designated proxy, specific healthcare decisions you authorize, and any restrictions you want to impose on the proxy's authority.
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