Fill in the requested member/patient information to receive their DocuBank information instantly. Click submit once complete to select how you would like to receive this information.
What is your relationship to the person whose healthcare directives you need?
Please click below to select how you would like to obtain the patient's documents:
Is this a life threatening emergency?
If checked, alerts will be sent to the emergency contacts if member is enrolled in this alert feature.
Enter the email address that your healthcare directives will be sent to:
Your delivery request has been received. Your healthcare directives will be emailed to . Depending on the recipient's email provider, this process may take up to 10 minutes. Recipient may also need to check their junk folder.
Enter the fax number that your healthcare directives will be delivered to:
Your delivery request has been received. Your healthcare directives will be faxed to . Depending on the size of your stored directives, this process may take up to 10 minutes to transmit.
Don't have the member's card? Having a problem with the information provided? Call our 24/7/365 emergency line at 610-639-9771 to reach an on-call DocuBank staff person.
