Myupmc proxy access 2026

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The document is an Adult Proxy Request Form from the University of Pittsburgh Medical Center (UPMC) that allows patients to designate a proxy who can access their health information through MyUPMC. It outlines the responsibilities and capabilities of the proxy, including requesting appointments, accessing medical information, and communicating with healthcare providers. The form emphasizes the importance of patient privacy and provides instructions for completing and submitting the request. It also includes terms and agreements regarding the use of MyUPMC.

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Click ‘Get Form’ to open the myupmc proxy access document in the editor.
Begin by filling out the Proxy’s Information section. Clearly print the name, gender, date of birth, home address, and contact details. Ensure all fields are completed accurately.
Next, move to the Patient’s Information section. Verify that the patient’s details are correct and provide any missing information as needed.
Review the MyUPMC Proxy Terms and Agreement carefully. Acknowledge your understanding by signing at the designated areas for both the proxy and patient.
Once completed, save your changes and return this form via mail or fax as instructed at the end of the document.

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