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Get the free MyChart Adolescent Proxy Form - MyNM

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Chart Application For Patients Ages 1217 Years (required for an adolescent to get their own Chart account)Completing this form allows an adolescent patient (the Patient) to access portions of his/her
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How to fill out mychart adolescent proxy form

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How to fill out mychart adolescent proxy form

01
Go to the MyChart website
02
Log in to your account
03
Click on the 'Forms' tab
04
Select the 'Adolescent Proxy Form' from the list of available forms
05
Fill out the required information for the adolescent and the proxy
06
Submit the form

Who needs mychart adolescent proxy form?

01
Parents or legal guardians who want access to their adolescent child's medical records
02
Caregivers or other individuals designated by the parent or legal guardian to access the adolescent's medical information
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MyChart adolescent proxy form is a form that allows a parent or guardian to access and manage the medical records of an adolescent patient.
A parent or guardian of an adolescent patient is required to file MyChart adolescent proxy form.
To fill out MyChart adolescent proxy form, the parent or guardian needs to provide their information, the adolescent patient's information, and sign the consent form.
The purpose of MyChart adolescent proxy form is to give parents and guardians access to their adolescent child's medical records and be able to make decisions on their behalf.
The MyChart adolescent proxy form must include the parent or guardian's contact information, the adolescent patient's information, and any preferences or restrictions regarding medical treatment.
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