Health Care Agent. By executing a form known as the Health Care Proxy, you may authorize an individual to make health care decisions for you in the event that you are no longer able to make those decisions for yourself. Facility encourages all residents to carefully consider and to execute a Health Care Proxy. If you have already designated someone to be your Health Care Agent, you are required to provide Facility with a copy of your Health Care Proxy form. The Social Worker can assist you in completing a Health Care Proxy form if you have not already designated someone to act as your Health Care Agent.
Health Care Agent. You also authorize the Facility to discuss protected health information, including lab and other test results, with your Health Care Agent and anyone else that you choose to provide the following assigned HIPAA Privacy Number . Facility also encourages all Residents to carefully consider and to execute a Health Care Proxy, which is a form in which you may authorize an individual to make health care decisions for you in the event that you are no longer able to make those decisions for yourself. You agree to provide the Facility with all documentation reflecting the appointment of your Health Care Agent. You may request a change in your DR, FR, Health Care Agent, HIPAA Privacy Number, or who may have access to your protected health information at any time. By signing this Agreement, you consent to the uses and disclosures of your protected health information for your care, payment for your care, and the Facility’s health care operations, and for such other uses that are permitted or required under federal or state law without your consent or authorization. The Facility may disclose to a family member, other relative, a close personal friend, or any other person identified by you your protected health information directly relevant to that person's involvement with your care or payment for your care. You authorize Facility to contact your DR, FR, and/or Health Care Agent whenever it is deemed appropriate by you or by Facility to seek the assistance of a third party in discussing and/or conducting your affairs. Each of the parties acting on behalf of the Resident referenced in this Section 1.2 shall be known as a “Resident Agent” in this Agreement.
