Please note: Different forms are required depending on whether you are the patient or a representative/guardian.
Please note: Different forms are required depending on whether you are the patient or a representative/guardian.
This form allows Boston Children’s Hospital to share, discuss, or receive information about a patient with others. It does not authorize the release of a certified copy of the medical record.
Patients aged 18 and older should have a healthcare proxy on file to ensure others know who can make medical decisions on their behalf if they become unable to do so.
This form allows families to temporarily delegate care decisions for a patient—up to 60 days. For example, use it if a grandparent is bringing the patient to one or more appointments at Boston Children’s.
Understand your rights and responsibilities as patients, patient representatives, and families.
This notice explains how your medical information may be used, shared, and how you can access it.
This manual reflects our core values and guides our strategic and operational decisions.