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ADULT PROXY Formulas complete the following information to authorize another adult access to your Chart account at Duly Health and Care (Duly). Please note: the patients' information will be accessed

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How to fill out mychart proxy access form

01

Visit the website of the healthcare provider that uses MyChart.

02

Look for the section on Proxy Access or Family Access.

03

Download the Proxy Access form.

04

Fill out the required information, including your name, contact information, and relationship to the patient.

05

Sign and date the form.

06

Submit the form to the healthcare provider according to their instructions.

Who needs mychart proxy access form?

01

Patients who may need assistance managing their healthcare information.

02

Caregivers or family members who need to access information on behalf of a patient.

03

Legal guardians or power of attorney holders who have the authority to make healthcare decisions for a patient.

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What is mychart proxy access form?

MyChart proxy access form is a form that allows a designated individual to access another person's MyChart account to view their medical information and communicate with their healthcare providers.

Who is required to file mychart proxy access form?

Anyone who wants to access another person's MyChart account on their behalf, such as a caregiver or legal guardian, is required to file the MyChart proxy access form.

How to fill out mychart proxy access form?

To fill out the MyChart proxy access form, the designated individual must provide their own personal information, the information of the patient whose account they wish to access, and specify the level of access they are requesting.

What is the purpose of mychart proxy access form?

The purpose of the MyChart proxy access form is to facilitate communication between patients, their designated individuals, and healthcare providers, as well as to allow for the viewing of medical information by authorized individuals.

What information must be reported on mychart proxy access form?

The MyChart proxy access form typically requires personal information of the designated individual, patient information, and specifies the level of access requested, such as viewing medical records or communicating with healthcare providers.

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