Adult proxy 2026

1. Click ‘Get Form’ to open the adult proxy form in the editor.
2. Begin by filling out your information in the 'Your Information' section. Ensure you provide your full name, last four digits of your SSN, date of birth, address, email, and phone number. Select your primary care organization from the provided options.
3. Next, complete the 'Patient’s Information' section with details about the adult whose health record you are requesting access to. This includes their name, last four digits of their SSN, date of birth, address, email, and phone number. Again, select their primary care organization.
4. Review the Allina Health account terms and agreement carefully. Acknowledge your understanding by signing in the designated area and indicating your relationship to the patient.
5. Finally, ensure that both you and the patient sign where required on the authorization for release of health information form. Remember that this authorization will expire after five years.

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