Get the free MyChart Adult Proxy Authorization Form - 8-30-16 version
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Patient Name: Date of Birth: Medical Record #:Authorization for Adult Proxy Access to Chart I authorize and request OrthoCarolina (OC) to grant my designated personal representative identified below
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What is mychart adult proxy authorization?
MyChart adult proxy authorization allows an individual to access another adult's MyChart account and act on their behalf.
Who is required to file mychart adult proxy authorization?
Any adult who wants to grant access to their MyChart account to another individual.
How to fill out mychart adult proxy authorization?
You can fill out MyChart adult proxy authorization by logging into your MyChart account, navigating to the proxy access section, and following the prompts to add a proxy.
What is the purpose of mychart adult proxy authorization?
The purpose of MyChart adult proxy authorization is to allow individuals to manage the health information and appointments of another adult.
What information must be reported on mychart adult proxy authorization?
The proxy must provide their name, relationship to the adult patient, and agree to the terms and conditions of proxy access.
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