Sanford proxy form 2026

1. Click ‘Get Form’ to open the Sanford Proxy Form in the editor.
2. Begin by filling out the 'About the Patient/Member' section. Clearly print your name, date of birth, last four digits of your Social Security Number, email, phone number, and Member ID Number if applicable.
3. Next, complete the 'About the Proxy' section for the individual you are granting access. Again, ensure all fields are filled out clearly including their name, date of birth, last four digits of their Social Security Number, email, street address, city, state, zip code, phone number, and Member ID Number if applicable.
4. Review the consent statements carefully. By signing this form, you grant your Proxy access to your complete medical records and authorize them to perform specific actions on your behalf.
5. Sign and date the form at the bottom. If mailing a notarized copy, ensure a notary witnesses your signature.

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