Osf adult proxy form 2026

1. Click ‘Get Form’ to open the OSF Adult Proxy Form in the editor.
2. Begin by filling out the 'Patient Information' section. Ensure you print clearly and include the patient's name, date of birth, address, phone number, city, state, zip code, email, and primary care doctor's name.
3. Next, complete the 'Proxy Information' section with the proxy's details. This includes their name, date of birth, address, phone number, city, state, zip code, and email.
4. Review the 'OSF myHealth Terms and Agreement'. Make sure to read each point carefully as it outlines responsibilities regarding account security and information sharing.
5. In the authorization sections for medical information release and mental health information release, fill in the required fields including patient name and signature. Ensure that all necessary signatures are obtained.
6. Finally, return all completed forms to your OSF Physician’s Office as instructed.

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