Requesting Limited Adolescent Proxy Access
In compliance with state and federal laws, there are special considerations for granting proxy access to an adolescent (age 12 to 17 years + 364 days) patient’s MyChart account. Adolescent patients have the right to limit what medical information they share via MyChart. These instructions pertain to requesting Limited Adolescent Proxy access, which does NOT require the adolescent patient’s consent.
For information about Adolescent Proxy Access, review Requesting Proxy Access to an Adolescent’s MyChart Account
If you are looking for a different type of access, review Accessing MyChart
Follow these steps to request Limited Adolescent Proxy Access to your adolescent’s MyChart account.
NOTE: You will need your own MyChart account to complete this process. If you do not have an active MyChart account, review Setting Up a MyChart Login for Yourself (Adult)
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Go to the login page for your partner healthcare organization.
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Click on "MyChart Enrollment Forms"
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In the MyChart Proxy Enrollment section, select the link for "Request Limited Proxy Access to an Adolescent's MyChart Information."
There are several forms here for different types of proxy request. Be sure to select the appropriate form link.
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Enter your personal information as the proxy.
This is YOUR information that is to be entered, not the patient’s.
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Enter the patient's information in the patient's fields.
This is the PATIENT’s information, not yours.
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Review the terms and sign the form.
This is your signature as the proxy, not the patient. The patient does not sign this form since their consent is not required for Limited Adolescent Proxy Access.
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Click "Submit Form" and await manual review.
MyChart Support Center staff will review the form to ensure the information is complete and accurate. The MyChart Support Center will contact the patient and parent/guardian to complete the process.
In compliance with state and federal laws, there are special considerations for granting proxy access to an adolescent (age 12 to 17 years + 364 days) patient’s MyChart account. Adolescent patients have the right to limit what medical information they share via MyChart. These instructions pertain to requesting Limited Adolescent Proxy access, which does NOT require the adolescent patient’s consent.
For information about Adolescent Proxy Access, review Requesting Proxy Access to an Adolescent’s MyChart Account
If you are looking for a different type of access, review Accessing MyChart
Follow these steps to request Limited Adolescent Proxy Access to your adolescent’s MyChart account.
NOTE: You will need your own MyChart account to complete this process. If you do not have an active MyChart account, review Setting Up a MyChart Login for Yourself (Adult)
-
Go to the login page for your partner healthcare organization.
-
Click on "MyChart Enrollment Forms"
-
In the MyChart Proxy Enrollment section, select the link for "Request Limited Proxy Access to an Adolescent's MyChart Information."
There are several forms here for different types of proxy request. Be sure to select the appropriate form link.
-
Enter your personal information as the proxy.
This is YOUR information that is to be entered, not the patient’s.
-
Enter the patient's information in the patient's fields.
This is the PATIENT’s information, not yours.
-
Review the terms and sign the form.
This is your signature as the proxy, not the patient. The patient does not sign this form since their consent is not required for Limited Adolescent Proxy Access.
-
Click "Submit Form" and await manual review.
MyChart Support Center staff will review the form to ensure the information is complete and accurate. The MyChart Support Center will contact the patient and parent/guardian to complete the process.