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MyChart Proxy (adult and minor)

Please print, fill out and submit this document to request access to an adult and minor’s MyChart account.

MyChart Self-Authorization

Fill out this form to allow Lakewood Health System to release your personal health information for you to access via MyChart.

No Surprise Billing Disclosure

Outdoor Visits at Lakewood Care Center

Letter sent to families of residents at Lakewood Care Center regarding outdoor visits, effective June 25, 2020.

Outdoor Visits at Lakewood Manor

Letter sent to families of tenants at Lakewood Manor regarding outdoor visits, effective June 25, 2020.

Outdoor Visits at Lakewood Pines

Letter sent to families of tenants of Lakewood Pines regarding outdoor visits, effective June 25, 2020.

Patient Request for Health Information Form

Use this form to request access to your health information.

Patient Verbal Consent

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.

Pharmacy Fees

Current, standard pharmacy charges at Lakewood Health System. Prices are current as of 1/1/2019 and are subject to change.