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MyChart Teen (1217yrs old)/Adult Proxy Authorization Patient Information Patient Name: ___DOB:___Address: ___ Contact phone:___ Email Address: ___Proxy Information Proxy Name:___DOB:___Address: ___
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MyChart for teens aged 12-17 is a secure online patient portal that allows teenagers to access their medical information, communicate with healthcare providers, and manage appointments.
Teens aged 12-17 who are receiving medical care and want to manage their health records online are required to file for MyChart access.
To fill out MyChart for teens, the teen must complete a registration form, provide necessary personal information, and possibly have consent from a parent or guardian depending on the healthcare provider's policy.
The purpose of MyChart for teens is to empower adolescents to take an active role in their healthcare management, allowing them to access their medical records, schedule appointments, and communicate directly with their healthcare providers.
Information that must be reported includes personal health information, appointment history, medication lists, and any other relevant medical history.
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