Authorization Forms for Proxy and Patient Access
| Access | Patient Age | Instructions |
|---|---|---|
| PARENT/GUARDIAN PROXY ACCESS | 11 years or younger | Click herehere to sign up for MyChart Access. Proxies of patients aged 11 and younger will have access to all of MyChart’s features, including self scheduling, messaging, chart access, and payment options. |
| 12 years old - 17 years old | Click herehere to sign up for MyChart Access. All parents/legal guardians/proxies of patients aged 12-17 can receive Standard Access by using the link above. Standard Access will allow users to schedule appointments, message your care team, and access health summary information. Enhanced Access will allow users the ability to view shared patient notes, test results, and potentially sensitive health information. Enhanced Access requires patient consent from patients aged 12-17 in compliance with State and Federal laws. Please have a conversation with the patient about this type of access. If the patient consents to the access, please complete the appropriate Proxy Access Authorization Form. |
|
| PATIENT ACCESS | 18 years old or older | Click herehere to sign up for MyChart Access. |