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Chart Adult Proxy Access Consent Form This form is to be used to give Chart access to parents/legal guardians of patients over the age of 18 PART I TO BE COMPLETED BY PATIENT Last Name First Name

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What is mychart adult proxy access?

MyChart adult proxy access allows designated individuals to access a patient's MyChart account to manage their healthcare needs.

Who is required to file mychart adult proxy access?

Family members or legal guardians who have been designated as proxies by the patient.

How to fill out mychart adult proxy access?

To fill out MyChart adult proxy access, the designated proxy must request access through the patient's healthcare provider and complete the required forms.

What is the purpose of mychart adult proxy access?

The purpose of MyChart adult proxy access is to allow designated individuals to assist with managing the healthcare needs of the patient.

What information must be reported on mychart adult proxy access?

The information reported on MyChart adult proxy access includes the proxy's relationship to the patient, contact information, and authorization to access the patient's health records.

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