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Chart Guardian/Conservator/POA of Adult Proxy Request and Authorization Form Page 1 of 2Patient Identifications form should be completed by a legal guardian, conservator, or acting durable Power of

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How to fill out mychart adult proxy authorization

01

Log in to your MyChart account.

02

Go to the 'Request Proxy Access' section.

03

Select the adult for whom you are requesting proxy access.

04

Fill out the required information, including your relationship to the adult and the duration of access.

05

Review and submit your request.

Who needs mychart adult proxy authorization?

01

Individuals who are legally authorized to make medical decisions on behalf of another adult

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What is mychart adult proxy authorization?

MyChart adult proxy authorization is a legal document that allows a designated individual to access and manage a patient's MyChart account.

Who is required to file mychart adult proxy authorization?

Any adult patient who wishes to designate a proxy to access their MyChart account is required to file mychart adult proxy authorization.

How to fill out mychart adult proxy authorization?

To fill out mychart adult proxy authorization, the patient must provide their information, the proxy's information, and specify the level of access the proxy will have.

What is the purpose of mychart adult proxy authorization?

The purpose of mychart adult proxy authorization is to allow a designated individual to access the patient's MyChart account in order to manage their medical information and appointments.

What information must be reported on mychart adult proxy authorization?

Mychart adult proxy authorization must include the patient's name, date of birth, contact information, the proxy's name, relationship to the patient, and level of access granted.

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