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The document is an Adult Proxy Form that allows an individual to request access to another adult's interactive health record at Allina Health. It requires the patient’s authorization and personal information, as well as the proxy's details. The form outlines responsibilities regarding account security, the nature of the health information accessed, and the voluntary nature of designating a proxy. It also includes terms for revocation of access and states that authorization expires after five years.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (45 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the responsibility of a proxy?

They are entrusted with the responsibility of carrying out tasks and making decisions that the principal would typically handle themselves. For example, in the corporate world, a proxy can be authorized to vote on behalf of a shareholder during a companys annual general meeting.

Can a family member be a proxy?

In all cases, a proxy must be of sound mind. Some people choose a family member, but others may decide on a trusted friend or neighbor or a lawyer.

What does it mean to be a persons proxy?

A type of advance directive that gives a person (called a proxy) the authority to make medical decisions for another person if that person is not able to make their own decisions. A proxy is usually a spouse, relative, friend, or lawyer who knows the persons values, wishes, and treatment preferences.

What is a patient proxy request?

A health care proxy is a document that allows you to appoint another person(s) as your health care agent to make health care decisions on your behalf if you are no longer able to do so. You may give your health care agent authority to make decisions for you in all medical situations if you cannot speak for yourself.