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MyChart Proxy Access Frequently Asked Questions

What is proxy access?
Proxy access lets you attach another MyChart account to yours. Depending on the type of proxy granted, you may have 24-hour access to:
• Appointments
• Immunizations records
• Medicine refills
• Secure messaging with the patient’s care providers
• More

What types of proxy access are available?
There are four types of proxy access:

What proxy forms do I need to complete?

• Adult-Adult:

Download and complete these two forms.

-MyChart Proxy Access Request form

-MyChart Adult Proxy Authorization Release of Information (to be completed by the person whose account you

are asking access to)

• Adult-Child:

Download and complete this form if your child is 0-11 years old.

-MyChart Proxy Access Request form

Download and complete this form for limited access if your child is 12-17 years old.

-MyChart Proxy Access Request form

• Young Adult:

Download and complete these two forms for full access if your child is 14-17 years old.

-MyChart Proxy Access Request form

-MyChart Young Adult (14-17) Teen Connection Request (to be completed by the young adult whose account you

are asking access to)

• Legal Guardian:

Download and complete these forms. Legal documentation to support your Guardianship or Power of Attorney

must accompany your request forms.

-MyChart Proxy Access Request form

-MyChart Adult Proxy Authorization Release of Information (to be completed by the person whose account you

are asking access to)

How do I get/give proxy access?
Complete the appropriate form(s) and mail, fax or deliver to:

Health Information Management Identity – Data Integrity
N17 W24100 Riverwood Drive, Suite 200
Waukesha, WI 53188
Fax: (262)544-9489

How do I take away access from someone who has proxy to my MyChart account?
To inactivate access to your account, download and complete this form. Mail, fax or deliver to the above address.

-MyChart Inactivation form

What happens after I send in the completed forms?
Once we receive your forms and proxy access is granted, access instructions will be sent to your MyChart account. If you do not have a MyChart account, the access instructions will be sent by U.S. mail to the address provided on the form.

Who can I contact if I have questions?
If you have questions or would like the proxy forms mailed to your home, call (877) 873-6305. MyChart support is available to assist you 24-hours a day, 7 days a week.