MyChart Access Forms

General Access Form
Any patient age 12 or older can have access to MyChart. If you did not recieve an activation code during a recent visit, please complete our MyChart Access Form (CLICK HERE).
Child Proxy Access
If you are a parent or legal guardian of a child under 18, complete one MyChart Parental/Guardian Access Application (CLICK HERE) for each child whose records you wish to access. After the application has been processed, you will see a new tab for the family member in your MyChart account. Parents/guardians may access their child’s full MyChart record if the child is 11 years of age or younger. Parents/guardians receive partial access to their child’s immunization records if the child is between 12 and 17 years of age. This policy is in place to protect the private conversations minors may have with their healthcare providers regarding their care.
Adult to Adult Access
To gain or grant access to another adult’s MyChart record, both adults must have an existing MyChart account. Learn how to sign up for MyChart. If both adults already have MyChart accounts, please complete the Adult/Adult Access Application (CLICK HERE).
Incapacitated Patient Access
If you are the caregiver for an adult who is unable to make medical decisions due to his/her condition and/or disability, please complete the MyChart Incapacitated Access Application (CLICK HERE) Copies of legal guardianship or durable power of attorney for healthcare documentation will need to be provided. This application, including guardianship, will need to be resubmitted on an annual basis.

Questions about what form to use?
Please call Health Information Management at 319-398-6161.