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FOR PATIENTS 18 AND OLDER MyChartProxyAccessRequest &AuthorizationForm Requirements: Proxy access to a UVM Health Network Chart account of an adult may be granted by the patient or his/her legal
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To fill out the mychartproxyaccessauthorizationform-forpatients18andolder 037358:
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Download the form from the official website or request a copy from the healthcare provider.
03
Read the instructions on the form carefully.
04
Provide the patient's full name, date of birth, and contact information.
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mychartproxyaccessauthorizationform-forpatients18andolder 037358 is needed by individuals who are 18 years old or older and wish to grant proxy access to another person for their MyChart account. Proxy access allows the designated individual to access and manage the patient's medical information and communicate with healthcare providers on their behalf.
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The form is used to authorize proxy access for patients 18 and older in the MyChart system.
Patients 18 years and older who wish to grant proxy access to another individual.
The form can be filled out online or printed and completed manually with the required information.
The purpose is to allow designated individuals to access a patient's health information through the MyChart system.
The form requires basic information about the patient, the designated proxy, and the type of access being granted.
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