Request to Access a Patient's Record

Please note that you will need a MyChart account of your own prior to obtaining proxy access to a minor.

If you already have a MyChart account of your own, please sign-in to your MyChart account and request the proxy access through your menu options (Sharing section: select “Request Access to a Minor’s Account”).

If you do not currently have a MyChart account, we highly recommend that you create one by clicking here and completing the sign-up form. Once you’re approved for access, you may request Proxy access via your menu option as mentioned above. If you’re unable to get approved for MyChart access via the online request, proceed with completing the form below and someone from our Medical Records department or clinics will connect with you. Please note that this process involves manual review and verification and will take longer.

Patient Age Access Level Definition
0 - 13 Full Access Full access to the patient's MyChart is permitted through the online Mychart Proxy Access request. Please follow the instructions below to request Proxy Access to a minor's account. Your request will be reviewed and the appropriate consent form will be sent to you in MyChart for signature.
14 - 17 Full Access Full access to a patient’s MyChart in this age group requires a signature from the patient as well as the requesting parent/guardian. This request cannot be submitted online, please proceed to your teen’s provider office/clinic with the teen to complete this Mychart Proxy Access request.
Limited Access Limited access to the patient’s MyChart is permitted through the online MyChart Proxy Access request. Limited Access displays a patient's Allergies, Immunizations, as well as the ability to electronically schedule appointments and communicate with the teen’s provider(s).
For certain medically necessary circumstances, the treating provider, in conversation with the patient and the parent/guardian, may authorize upgrading to full access without a patient signature.
Transitional Periods Parent/Guardian’s Full proxy access to a minor’s MyChart is automatically transitioned to “Limited” access once the minor reaches 14 years of age. Parent/Guardian’s full access may be reinstated with a physical signature from the minor at the provider office/clinic.
Parent/Guardian’s Full or Limited proxy access to a minor’s MyChart is automatically terminated/expired once the minor reaches 18 years of age. The 18 year old patient may grant the parent/guardian with limited or full access through his/her MyChart account.
18+ Parent/Guardian Full Access to the patient's MyChart for a family member is permitted with an invitation from the patient and acceptance of the Proxy Terms and Conditions. The patient can log into their MyChart account and invite someone else to see their record through the menu option (“Share: Give access to another Adult”).
Full Access may also be requested by following the instructions below but may take longer as it will require a manual review and obtaining a signature from the patient via MyChart.
Caregiver Full access may be granted to a Caregiver for a patient’s MyChart if the patient’s medical condition necessitates that (e.g. patients with diminished capacity). Some documentation may be required to complete this request online or at the provider office/clinic.

Use this form to request MyChart access to a minor. Enter information about the minor to whom you are requesting access as well as information about yourself. All fields are required.

Your Information:

Minor Information:

The person you are requesting MyChart access to.