complete both pages of this form. The patient must sign this form and provide authorization on page 2 via the “Adult Proxy Authorization for Access to Medical Information” form. The patient’s account will be accessed through your (the proxy’s) MyChart account.
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A free step-by-step booklet and discussion guide on advance care planning, including the health care proxy form, are available for download at CompassionAndSupport.org. Results of Excellus BCBS’s end-of-life survey establish a benchmark for awareness and completion of the health care proxy among upstate New York adults. A web proxy site is a website with an address bar. Just input the URL of the blocked site into that bar and click the "Surf" button. Web proxy sites will fetch the web page for you and show it on its own site.
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