MyUnityPoint Proxy

By clicking below, users can request online access to medical information for their children or another in their care that has impaired decision-making abilities. Adult patients may also authorize spouses, adult children, or others to have access to their existing account.​

Disclosure Authorization Form

​Use this form to authorize Associated Physicians to discuss or disclose your protected health information to the people that you specify.

Medicare Educational Resources

To monitor Medicare, the government has several processes and forms in place that may be new to you. We are required to strictly adhere to these Medicare requirements. 

Release of Information

Please complete this form to release PHI or protected health information.

Transfer of Medical Records/Authorization for Release of Records

To request copies of or to transfer your medical records, you must submit a request in writing using this form. Your records will then be sent to the requested entity through a secure portal. Requests can take 1-2 weeks to process, depending on the information requested.

Advance Directives

If you or your loved one needs help making decisions about healthcare, you can find Power of Attorney and Living Will forms by clicking below. Please present these forms when you arrive for your visit.

Worker’s Comp and Third Party Liability

Please complete this form if you have been injured in an accident at work or when another party is responsible

Family and Friends Communications Permissions

Please complete this form to release PHI or protected health information.