Get the free MyChart Adult Proxy Authorization Form - 8-30-16 version

Patient Name: Date of Birth: Medical Record #: Authorization for Adult Proxy Access to Chart (Last updated 83016) I authorize and request Duke University Health System* and Private Diagnostic Clinic

How to fill out mychart adult proxy authorization

How to fill out MyChart adult proxy authorization:

1. Visit the MyChart website and log in to your account.
2. Navigate to the "Proxy Access" section or search for "proxy authorization" in the search bar.
3. Click on "Request Proxy Access" or a similar option.
4. Fill in the required information, such as your name, relationship to the adult patient, and contact details.
5. Agree to the terms and conditions of the proxy access.
6. Review the information you provided and make any necessary changes.
7. Submit your request for proxy access.
8. Wait for the approval of your request. You may receive a confirmation email or notification on your MyChart account.
9. Once approved, you will have access to the adult patient's MyChart account.

Who needs MyChart adult proxy authorization?

1. Family members or legal guardians who need access to an adult patient's medical information.
2. Caregivers or healthcare providers responsible for coordinating or managing the care of an adult patient.
3. Individuals who have been granted legal authority to make healthcare decisions on behalf of an adult patient.

Note: The need for MyChart adult proxy authorization may vary depending on the policies of the healthcare institution and the specific circumstances of the adult patient. It is recommended to consult with the healthcare provider or the institution's MyChart support team for clarification.

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What is mychart adult proxy authorization?

MyChart adult proxy authorization allows a designated individual to access and manage a MyChart account on behalf of an adult patient.

Who is required to file mychart adult proxy authorization?

The adult patient who wishes to grant access to a designated individual must file the MyChart adult proxy authorization form.

How to fill out mychart adult proxy authorization?

To fill out the MyChart adult proxy authorization form, the adult patient must provide their information, designate the individual who will have access, and sign the form.

What is the purpose of mychart adult proxy authorization?

The purpose of MyChart adult proxy authorization is to allow a designated individual to access and manage a MyChart account on behalf of an adult patient.

What information must be reported on mychart adult proxy authorization?

The MyChart adult proxy authorization form requires the adult patient's information, the designated individual's information, and the signature of the adult patient.