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Child Proxy Form Access to Your Child's Chart Record To sign up for access to your children Chart record, please complete both pages of this Child Proxy Form and return it to the address shown below.

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Parents or legal guardians who want to access and manage the medical records of a child under the age of 12 through the MyChartLink system need to fill out the 'mychartchildproxyformchild under 12 proxy' form.

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mychartlinkcomdocsfhmychartchildproxyformchild under 12 proxy is a form that allows a parent or legal guardian to act as a proxy for a child under the age of 12 in accessing their healthcare information.

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To fill out mychartlinkcomdocsfhmychartchildproxyformchild under 12 proxy, the parent or legal guardian must provide their information, the child's information, and consent to act as a proxy for the child's healthcare information.

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