Search Results: 11 Documents
Authorization to release behavioral health information form.
This is the authorization form to release medical records and/or x-rays.
Fill out this form to give full access to your MyChart account information to another person.
Fill out this form if you are a minor who is granting access to your MyChart account to another person (parent, guardian, etc.).
Fill out this form to allow Lakewood Health System to release your personal health information for you to access via MyChart.
Use this form to request access to your health information.
Patients will no longer be signing an electronic consent when registering for their appointment. They will instead be asked to provide verbal consent to: (1) release their information for treatment, payment, and operations purposes; assign their benefits; contact their cellular phone; and acknowledge the Patient Bill of Rights and Notice of Privacy Practices information.
This verbal consent form provides the details of that consent.
Proxy Consent for Routine Care form allows Lakewood to provide routine medical care for patients.
Fill out this form to revoke someone’s proxy access to your MyChart account.