Santa clara valley medical center my health online 2026

1. Click ‘Get Form’ to open the Authorization to Grant Access to Health Information in myHealth Online form in the editor.
2. Begin by entering your Patient Name and Medical Record Number at the top of the form. Ensure that all information is accurate for proper identification.
3. Fill in the Date field to indicate when you are completing this authorization. This helps maintain a record of your request.
4. In the Authorization section, provide the Full Legal Name, Birth date, and Medical Record Number of both the adult patient and the proxy representative who will be granted access.
5. Complete the Proxy Representative's mailing address and email fields. This information is essential for communication regarding access.
6. Indicate whether the Proxy Representative is a SCVHHS patient by checking 'Yes' or 'No'. If yes, include their Medical Record Number.
7. Finally, sign and date the form at the bottom, ensuring that you have read and agree to all terms outlined in the document before submission.

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