Name: | DOB: | MRN: | PCP:

Request MyChart Proxy Access to a Patient's Record

Proxy Access for Minors Under 18 Years of Age

Proxy access is available for parents and/or guardians of minors under the age of 18. Proxy access submission for minors under 12 is with one form. For patients 12 years or older the parent/guardian must submit a request and the patient must submit the 12-17 Year Old Agreement. For the 12-17 year old patients, the parent/guardian get Proxy Access and the patient gets their own MyChart account.

For access to a minor under 12 years of age:


For access to a minor between 12-17 years of age, the parent/guardian must fill out the "Request Proxy Access for Child 12 to 17 Years of Age" and the minor must fill out the "12-17 Year Old Patient MyChart Agreement for Access":


Proxy Access for Patients Over 18 Years Old

For access to a patient over the age of 18, the patient can login to their own MyChart account and invite others to have Proxy Access to their account.