Mykelseyonline 2025

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The document is an Adult Proxy/Release of Information Form from Kelsey-Seybold Clinic, allowing patients to authorize another adult to access their medical information through the MyKelseyOnline account. It outlines the necessary information required from both the patient and the proxy, details the scope of information that can be accessed, and emphasizes that participation is voluntary. The form also includes provisions for revocation of consent and clarifies that once disclosed, the information may be re-disclosed by the proxy.

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2014	4.5 Satisfied (45 Votes)

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