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- Click ‘Get Form’ to open the Sutter Health Doctors Note in the editor.
- Begin by entering the Medical Record Number (MRN) and Date of Birth (DOB) at the top of the form. This information is crucial for identifying the patient.
- Select your Sutter affiliate or hospital from the provided options. If applicable, write in the name of your provider or hospital.
- Fill out the section requesting online access to medical records for a minor child. Ensure you complete all fields legibly, including the patient's name, phone number, and last four digits of their SSN.
- Provide details for the Proxy Representative, including their relationship to the child and contact information. Remember that legal documents may be required based on your relationship.
- Sign and date the form as a Proxy Representative before submitting it via fax or mail to ensure timely processing.
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