How to complete the Authorized Representative Form? Name of member: Fill in the SCFHP Medi-Cal member's full name.A grandparents' medical consent form allows a parent or legal guardian to hand over all responsibility regarding their child's healthcare decisions. To do this, Santa Clara Valley Medical Center (SCVMC) requires a completed and signed form before we can release the records to anyone, including the patient. This information is required to conform to CCR Title 22 regulations, to ensure a continuum of care to the resident, client or child. We've made all the necessary forms available for download on our website. We encourage you to review the forms carefully and fill them out completely. On this page below is a list of LOCAL forms that can be completed online and then printed. The form you need may be in this list. Do not use for patient copies of or access to their medical records.