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Demographics
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Medical Hx
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Agreement
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Billing
5
HIPAA
Step 5 — Optional
Emergency Contact & Third-Party Access
Designate an emergency contact and, if you choose, authorize KC Primary Care to share your health information with a trusted person — a family member, caregiver, or employer. Entirely optional and does not affect your membership.
Authorize third-party access & designate an emergency contact
This is also where you can designate an emergency contact. If there’s someone you want KC Primary Care to be able to speak with about your care — a spouse, parent, caregiver, or other trusted person — you can authorize that here. If not, skip and you’re done.
You can always add or change this authorization after enrollment by contacting our office.