Get the free MyChart Proxy Access Authorization Form

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I further agree to comply with the Terms and Conditions and Proxy Disclaimer. Proxy Signature // POA/Guardianship documentation must be included with this form if applicable Supplemental Use Agreement and Parental Authorization Parents or legal guardians can use MyChart to access medical information for their children who are under the age of 18. MyChart Proxy Access Authorization Form Name Patient Email Patient Date of Birth Patient MRN Name of Proxy Proxy Email Proxy Address Proxy DOB...

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How to fill out mychart proxy access authorization

01

Step 1: Go to the MyChart website or open the MyChart mobile app on your device.

02

Step 2: Log in to your own MyChart account using your username and password.

03

Step 3: Once logged in, navigate to the 'Settings' or 'Account' section of MyChart.

04

Step 4: Look for the 'Proxy Access' or 'Authorized Access' option and click on it.

05

Step 5: Follow the instructions provided to initiate the process of adding proxy access.

06

Step 6: Provide the necessary information about the person you want to grant proxy access to.

07

Step 7: You may be required to provide consent or confirm the proxy access request.

08

Step 8: Review the terms and conditions, if any, associated with proxy access authorization.

09

Step 9: Submit the request or authorization form after ensuring all information is accurate.

10

Step 10: Wait for the system to process the request. You may receive a confirmation email once the process is complete.

Who needs mychart proxy access authorization?

01

Patients who are unable to manage their own MyChart account due to age or health conditions may need proxy access authorization.

02

Minor children under the age of 18 usually require a parent or legal guardian to have proxy access to their MyChart account.

03

Caregivers or family members may need proxy access to assist a patient in managing their healthcare information.

04

Patients who want to grant access to their medical records or appointment scheduling to a trusted person may also need proxy access.

05

Individuals who are authorized to make medical decisions on behalf of a patient may require proxy access to MyChart.

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